Organization
BOULEVARD PHARMACY INC
Active
Other names
Boulevard Homecare Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KIRK DESHAZO (PRESIDENT/OWNER)
(918) 336-2388
Entity
Organization
Contact information
Practice address
1117 SE FRANK PHILLIPS BLVD, BARTLESVILLE, OK 74003-4319
(918) 336-2388
(918) 336-0016
Mailing address
1117 SE FRANK PHILLIPS BLVD, BARTLESVILLE, OK 74003-4319
(918) 336-2388
(918) 336-0016
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100232160B
—
OK
Enumeration date
11/08/2006
Last updated
12/08/2021
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