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General NPI Number Information
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NPI Number | 1760810071
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Entity Type | Organization
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Legal Business Name | BROOKHAVEN SPECIALTY PHARMACY LLC
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Dates
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Enumeration Date | 10/23/2013
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Last Update Date | 05/23/2016
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Provider Practice Location Address
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Address Line | 3750 W ROBINSON ST SUITE 150
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City | NORMAN
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State | OK
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Zip | 73072-3660
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Country | US
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Telephone | 580-421-6929
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Fax |
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Provider Business Mailing Address
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Address Line | 5874 S MINGO RD
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City | TULSA
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State | OK
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Zip | 74146-6425
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Country | US
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Telephone | 918-695-0167
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Fax |
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Authorized Official
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Title or Position | PHARMACIST/PIC
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Name | MRS. KRISTY LAUREN DAVIS
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Credential | PHARMD
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Telephone | 405-801-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 7-6445
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License Number State | OK
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