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Organization

FAIRFAX PHARMACY LLC

Active
Other names
OGM Investments
Organization subpart
No

Provider details

NPI number
Authorized official
KIMBERLY TILLEY PHARMD (OWNER)
(918) 642-1200
Entity
Organization

Contact information

Practice address
400 N MAIN ST, FAIRFAX, OK 74637-1548
(918) 642-1200
(918) 642-1202
Mailing address
PO BOX 367, FAIRFAX, OK 74637-0367

Taxonomy

Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
16-9003
STATE LICENSE
OK
Enumeration date
07/13/2021
Last updated
03/08/2022
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