Organization
OLYMPIA PHARMACY LLC
Active
Other names
OLYMPIA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN CRISMON DPH (PHARMACIST)
(918) 388-5713
Entity
Organization
Contact information
Practice address
6802 S OLYMPIA AVE, STE 125, TULSA, OK 74132-1823
(918) 398-6279
Mailing address
6802 S OLYMPIA AVE, STE 125, TULSA, OK 74132-1823
(918) 398-6279
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
25302
OK
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3725225
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/16/2008
Last updated
02/20/2013
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