MEDICARE: CLAREMORE COMPOUNDING CENTER, 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	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-9024	OTHER	OK	STATE BOARD LICENSE

General Provider Information

NPI Number	:	1871255166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLAREMORE COMPOUNDING CENTER, INC

Provider Business Mailing Address
First Line	:	1000 W WILSHIRE BLVD STE 401
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-7003
Country	:	US
Telephone Number	:	405-754-1090
Fax Number	:	405-594-6007

Provider Business Practice Location Address
First Line	:	1000 W WILSHIRE BLVD STE 401
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-7003
Country	:	US
Telephone Number	:	405-754-1090
Fax Number	:	405-594-6007

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	BRITTNEY BENCE
Credential	:
Telephone Number	:	918-283-3784

Provider Enumeration Date	:	10/13/2021
Last Update Date	:	03/07/2023

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