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General NPI Number Information
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NPI Number | 1942340898
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Entity Type | Organization
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Legal Business Name | COMMUNITY PHARMACY, LLC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3125 SW 89 ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73159
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Country | US
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Telephone | 405-605-7700
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Fax | 405-605-7712
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Provider Business Mailing Address
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Address Line | 205 NW 63RD ST SUITE 300
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-8254
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Country | US
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Telephone | 405-419-7716
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. ED GRAY
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Credential |
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Telephone | 405-419-7716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 1-5137
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License Number State | OK
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