MEDICARE: JIMARDE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0004X	Compounding Pharmacy
2	3336C0003X	Community/Retail Pharmacy	1-4510	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2076404	OTHER		PK

General Provider Information

NPI Number	:	1134205685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JIMARDE INC

Provider Business Mailing Address
First Line	:	908 STRAKA TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-2534
Country	:	US
Telephone Number	:	405-605-0346
Fax Number	:	405-605-0348

Provider Business Practice Location Address
First Line	:	908 STRAKA TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-2534
Country	:	US
Telephone Number	:	405-605-0346
Fax Number	:	405-605-0348

Authorized Official
Title or Position	:	OWNER
Name	:	JIM HUFF
Credential	:	RPH
Telephone Number	:	405-605-0346

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	05/24/2016

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Directions to “JIMARDE INC ” Practice Location

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