Organization
COMMUNITY PHARMACY LLC
Active
Other names
FOUNTAIN PARK PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ED GRAY (DIRECTOR)
(405) 419-5478
Entity
Organization
Contact information
Practice address
3125 SW 89TH ST, OKLAHOMA CITY, OK 73159-7901
(405) 605-7700
(405) 605-7712
Mailing address
3125 SW 89TH ST, OKLAHOMA CITY, OK 73159-7901
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
15137
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3724754
OTHER ID NUMBER
—
Enumeration date
12/22/2006
Last updated
08/31/2007
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