# HEALTHCARE PHARMACY OF OKLAHOMA INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Reavis Specialty Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063840437
- **Authorized official:** JULIE JUSTICE (AUTHORIZED AGENT)
- **Authorized official phone:** (405) 447-3911

## Contact information

- **Practice address:** 110 BURR AVE STE A, PAULS VALLEY, OK 73075-3848
- **Practice address phone:** (405) 238-2755
- **Practice address fax:** (405) 238-7357
- **Mailing address:** 110 BURR AVE STE A, PAULS VALLEY, OK 73075-3848
- **Mailing address phone:** (405) 238-2755
- **Mailing address fax:** (405) 238-7357

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 22-6367 | OK | Yes |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 10/23/2013
- **Last updated:** 11/06/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2142503 | PK | — |