=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518337302
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UGC-2, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2015
-----------------------------------------------------
Last Update Date | 09/17/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9515 N MAY AVE
-----------------------------------------------------
City | THE VILLAGE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73120-2709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-286-9932
-----------------------------------------------------
Fax | 405-286-9832
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2740 FEATHERSTONE RD
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73120-2122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-302-6273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | LINCY FENG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 405-302-6282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 1-7446
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------