Organization
23RD STREET PHARMACY LLC
Active
Other names
23rd Street Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MICKEY PHAN (OWNER)
(405) 513-0710
Entity
Organization
Contact information
Practice address
2316 NW 23RD ST, OKLAHOMA CITY, OK 73107-2406
(405) 602-6442
(405) 602-6449
Mailing address
2316 NW 23RD ST, OKLAHOMA CITY, OK 73107-2406
(405) 602-6442
(405) 602-6449
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
16693
OK
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2133976
PK
—
Enumeration date
03/13/2012
Last updated
06/16/2016
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