Organization
PROVIDENTIA LLC
Active
Other names
Freeland Brown Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW AARON KOHLER (OWNER/MANAGER)
(918) 743-4491
Entity
Organization
Contact information
Practice address
4112 S PEORIA AVE, TULSA, OK 74105-7613
(918) 743-4491
(918) 743-5432
Mailing address
4112 S PEORIA AVE, TULSA, OK 74105-7613
(918) 743-4491
(918) 743-5432
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2-5706
OK
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100232760 A
—
OK
05
—
100232760 B
—
OK
01
—
2130880
PK
—
Enumeration date
07/08/2006
Last updated
07/28/2020
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