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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