MEDICARE: INTEGRIS PROHEALTH 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	3336C0003X	Community/Retail Pharmacy	16898	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2141245	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679614531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRIS PROHEALTH INC

Provider Business Mailing Address
First Line	:	3435 NW 56TH ST STE 301A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4428
Country	:	US
Telephone Number	:	405-713-7407
Fax Number	:	405-815-6445

Provider Business Practice Location Address
First Line	:	4221 S WESTERN AVE STE 1020
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3448
Country	:	US
Telephone Number	:	405-636-7717
Fax Number	:	405-636-7542

Authorized Official
Title or Position	:	TREASURER
Name	:	MICHAEL L WEED
Credential	:
Telephone Number	:	405-951-2737

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	11/06/2025

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Directions to “INTEGRIS PROHEALTH INC ” Practice Location

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