MEDICARE: MARK'S PRESCRIPTION SHOP 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	14653	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	2073479	OTHER		PK

General Provider Information

NPI Number	:	1285727628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK'S PRESCRIPTION SHOP INC

Provider Business Mailing Address
First Line	:	7201 E RENO AVE
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-4484
Country	:	US
Telephone Number	:	405-737-3451
Fax Number	:	405-733-7061

Provider Business Practice Location Address
First Line	:	7201 E RENO AVE
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-4484
Country	:	US
Telephone Number	:	405-737-3451
Fax Number	:	405-733-7061

Authorized Official
Title or Position	:	PRESIDENT PHARMACIST
Name	:	MARK STRIMPLE
Credential	:	PHARM D
Telephone Number	:	405-737-3451

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	05/24/2016

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Directions to “MARK'S PRESCRIPTION SHOP INC ” Practice Location

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