Organization
TBCPM LLC
Active
Other names
The Broadway Clinic Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JANIE SHACKELFORD (PIC)
(405) 429-5138
Entity
Organization
Contact information
Practice address
1801 N BROADWAY AVE, OKLAHOMA CITY, OK 73103-3446
(405) 429-5138
(405) 521-8260
Mailing address
1801 N BROADWAY AVE, OKLAHOMA CITY, OK 73103-3446
(405) 429-5138
(405) 521-8260
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1-5535
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2126994
PK
—
Enumeration date
10/14/2010
Last updated
11/02/2016
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