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General NPI Number Information
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NPI Number | 1538460795
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Entity Type | Organization
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Legal Business Name | OK COMPOUNDING LLC
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Dates
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Enumeration Date | 11/04/2010
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Last Update Date | 05/08/2013
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Provider Practice Location Address
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Address Line | 102 N BROADWAY
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City | SKIATOOK
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State | OK
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Zip | 74070
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Country | US
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Telephone | 918-396-0100
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Fax | 918-396-0113
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Provider Business Mailing Address
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Address Line | 102 N BROADWAY
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City | SKIATOOK
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State | OK
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Zip | 74070
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Country | US
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Telephone | 918-396-0100
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Fax | 918-396-0113
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Authorized Official
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Title or Position | PARTNER/MANAGING OFFICER
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Name | CHRISTOPHER PARKS
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Credential |
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Telephone | 918-396-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 2-6161
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License Number State | OK
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