Organization
TCAACP LLC
Active
Other names
PRESCRIPTIONS COMPOUNDING PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CALEB MEACHAM DPH (OWNER)
(918) 251-6655
Entity
Organization
Contact information
Practice address
511 S ASPEN AVE, BROKEN ARROW, OK 74012-2296
(918) 251-6655
(918) 251-6622
Mailing address
511 S ASPEN AVE, BROKEN ARROW, OK 74012-2296
(918) 251-6655
(918) 251-6622
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
25915
OK
3336C0004X
Compounding Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100247200A
—
OK
01
—
2076439
PK
—
Enumeration date
06/09/2006
Last updated
05/26/2016
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