MEDICARE: SCWW 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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1770128084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCWW LLC

Provider Business Mailing Address
First Line	:	13301 N MERIDIAN AVE STE 400
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8357
Country	:	US
Telephone Number	:	405-755-4600
Fax Number	:	405-286-3565

Provider Business Practice Location Address
First Line	:	13301 N MERIDIAN AVE STE 400
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8357
Country	:	US
Telephone Number	:	405-755-4600
Fax Number	:	405-286-3565

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	PEGGY J RAY
Credential	:	DPH
Telephone Number	:	405-755-4600

Provider Enumeration Date	:	11/11/2019
Last Update Date	:	11/11/2019

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Directions to “SCWW LLC ” Practice Location

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