Organization
OK COMPOUNDING
Active
Other names
OK COMPOUNDING
Organization subpart
No
Provider details
NPI number
Authorized official
STACIE MILLER (PHARMACIST IN CHARGE, PARTNER)
(918) 396-0100
Entity
Organization
Contact information
Practice address
102 BROADWAY, SKIATOOK, OK 74070
(918) 396-0100
(918) 396-0113
Mailing address
102 BROADWAY, SKIATOOK, OK 74070
(918) 396-0100
(918) 396-0113
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
Primary
166161
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3727154
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/31/2013
Last updated
01/31/2013
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