Organization
THERACOMPRX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH WAYNE BAILES II RPH, PHARMD (PHARMACIST-IN-CHARGE/OWNER)
(580) 759-6238
Entity
Organization
Contact information
Practice address
1414 ARLINGTON ST, STE 2200, ADA, OK 74820-2646
(580) 436-9922
(580) 436-9919
Mailing address
1414 ARLINGTON ST, STE 2200, ADA, OK 74820-2646
(580) 436-9922
(580) 436-9919
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
23-6620
OK
Other
Enumeration date
03/07/2014
Last updated
03/07/2014
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