Organization
PROVIDENTIA LLC
Active
Other names
Freeland Brown Pharmacy No. 2
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL DOTSON BS PHARMACY (OWNER)
(918) 688-9149
Entity
Organization
Contact information
Practice address
1507 W 51ST ST, TULSA, OK 74107-8041
(918) 446-1404
(918) 794-1610
Mailing address
4112 S PEORIA AVE, TULSA, OK 74105-7613
(918) 743-4491
(918) 743-5432
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2-6651
OK
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100235670G
—
OK
01
—
2144892
PK
—
Enumeration date
11/03/2006
Last updated
11/08/2016
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