Organization · NPI-2

23rd Street Pharmacy LLC

Pharmacy, Community/Retail Pharmacy · Oklahoma City, OK

NPI number1215202064
StatusActive
Last updated in NPPESJun 16, 2016

Details

NPI
1215202064
Entity type
Organization (NPI-2)
Legal business name
23rd Street Pharmacy LLC
Organization subpart
No
Enumeration date
Mar 13, 2012
Last updated
Jun 16, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
3336C0003X Pharmacy, Community/Retail Pharmacy16693OKYes
3336L0003X Pharmacy, Long Term Care Pharmacy––

Other names

  • 23rd Street Pharmacy (Doing Business As)

Practice location

2316 Nw 23rd St
Oklahoma City, OK 73107-2406

Phone 405-602-6442 · Fax 405-602-6449

Mailing address

2316 Nw 23rd St
Oklahoma City, OK 73107-2406

Phone 405-602-6442 · Fax 405-602-6449

Authorized official

Mickey Phan
Owner
4055130710

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Pharmacy, Community/Retail Pharmacy providers in Oklahoma City, OK