=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528934346
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YUKON RX INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2025
-----------------------------------------------------
Last Update Date | 10/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11101 SURREY HILLS BLVD
-----------------------------------------------------
City | YUKON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73099-8155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-373-1717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11101 SURREY HILLS BLVD
-----------------------------------------------------
City | YUKON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73099-8155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-373-1717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOHN SMITH
-----------------------------------------------------
Credential | PHARM.D.
-----------------------------------------------------
Telephone | 405-373-1717
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------