Organization
PATRIOT PHARMACIES LLC
Active
Other names
Patriot Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID O ROURKE (OWNER)
(918) 298-4153
Entity
Organization
Contact information
Practice address
329 S ELM ST STE 130, JENKS, OK 74037-3777
(918) 298-4153
(918) 298-4272
Mailing address
329 S ELM ST STE 130, JENKS, OK 74037-3777
(918) 298-4153
(918) 298-4272
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2-7611
OK
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200662580A
—
OK
01
—
2168433
PK
—
Enumeration date
04/05/2017
Last updated
04/05/2017
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