Organization
PROVIDENCE RX INC
Active
Other names
Providence RX Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
LISA AILEEN OWENS DPH (PRESIDENT)
(918) 808-6228
Entity
Organization
Contact information
Practice address
7302 S YALE AVE STE 101, TULSA, OK 74136-7032
(918) 392-3366
(918) 392-2950
Mailing address
7302 S YALE AVE STE 101, TULSA, OK 74136-7032
(918) 808-6228
(918) 392-2950
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200785950A
—
OK
Enumeration date
08/20/2018
Last updated
03/04/2022
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