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General NPI Number Information
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NPI Number | 1851403406
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE HEALTH SERVICES
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 6600 S YALE AVE SUITE 110
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City | TULSA
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State | OK
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Zip | 74136-3310
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Country | US
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Telephone | 918-488-6660
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Fax | 918-488-6665
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Provider Business Mailing Address
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Address Line | 6600 S YALE AVE SUITE 110
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City | TULSA
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State | OK
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Zip | 74136-3310
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Country | US
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Telephone | 918-488-6660
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Fax | 918-488-6665
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JAY M TIPPS
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Credential | DPH
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Telephone | 918-488-6660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2-4580
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License Number State | OK
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