Organization
EAGLET PHARMACY LLC
Active
Other names
Eaglet Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
VALIMOHAMMED PANARA (MANAGER)
(405) 676-5300
Entity
Organization
Contact information
Practice address
2209 SW 104TH ST STE E, OKLAHOMA CITY, OK 73159-7551
(405) 676-5300
(405) 676-5321
Mailing address
2209 SW 104TH ST STE E, OKLAHOMA CITY, OK 73159-7551
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-9605
BOARD OF PHARMACY
OK
05
—
201224190A
—
OK
Enumeration date
01/19/2024
Last updated
02/22/2024
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