MEDICARE: EAGLET PHARMACY LLC

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	3336C0003X	Community/Retail Pharmacy

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	1-9605	OTHER	OK	BOARD OF PHARMACY

General Provider Information

NPI Number	:	1447011135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLET PHARMACY LLC

Provider Business Mailing Address
First Line	:	2209 SW 104TH ST STE E
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7551
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2209 SW 104TH ST STE E
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7551
Country	:	US
Telephone Number	:	405-676-5300
Fax Number	:	405-676-5321

Authorized Official
Title or Position	:	MANAGER
Name	:	VALIMOHAMMED PANARA
Credential	:
Telephone Number	:	405-676-5300

Provider Enumeration Date	:	01/19/2024
Last Update Date	:	02/22/2024

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Directions to “EAGLET PHARMACY LLC ” Practice Location

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