MEDICARE: ZRC 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	3336C0004X	Compounding Pharmacy
2	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	1-8329	OTHER	OK	PHARMACY LICENSE

General Provider Information

NPI Number	:	1932679099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZRC PHARMACY, LLC

Provider Business Mailing Address
First Line	:	7158 NW 112TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-2773
Country	:	US
Telephone Number	:	405-517-6104
Fax Number	:

Provider Business Practice Location Address
First Line	:	7158 NW 112TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-2773
Country	:	US
Telephone Number	:	405-470-7008
Fax Number	:	405-470-1040

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	GREGORY CLYDE
Credential	:	DPH
Telephone Number	:	405-517-6104

Provider Enumeration Date	:	12/03/2018
Last Update Date	:	01/25/2022

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Directions to “ZRC PHARMACY, LLC ” Practice Location

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