MEDICARE: EPIC 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-8487	OTHER	OK	STATE LICENSE

General Provider Information

NPI Number	:	1568015659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EPIC PHARMACY LLC

Provider Business Mailing Address
First Line	:	2249 NW 39TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-8831
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2249 NW 39TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-8831
Country	:	US
Telephone Number	:	405-724-7852
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	HAMZA MUHAMMAD
Credential	:
Telephone Number	:	405-724-7852

Provider Enumeration Date	:	07/18/2019
Last Update Date	:	08/13/2019

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Directions to “EPIC PHARMACY LLC ” Practice Location

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