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General NPI Number Information
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NPI Number | 1811995301
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Entity Type | Organization
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Legal Business Name | OKEMAH PHARMACY INC.
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 10/21/2014
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Provider Practice Location Address
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Address Line | 623 W MAIN ST
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City | HENRYETTA
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State | OK
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Zip | 74437-4245
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Country | US
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Telephone | 918-652-3361
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Fax | 918-652-9554
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Provider Business Mailing Address
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Address Line | 623 W MAIN ST
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City | HENRYETTA
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State | OK
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Zip | 74437-4245
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Country | US
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Telephone | 918-652-3361
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Fax | 918-652-9554
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | MR. ELMER ALLEN FRECH
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Credential | R.PH.
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Telephone | 918-652-3361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 14-5411
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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