NPI | 1225518079 |
---|---|
Doing Business As | PROVIDENCE RX PHARMACY |
Entity Type | Organization |
Authorized Contact | LISA AILEEN OWENS President 918-808-6228 |
Organization Subpart ? | No |
Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
3336L0003X Pharmacy, Long Term Care Pharmacy | |
Enumeration Date | 2018-08-20 |
Last Update Date | 2022-03-04 |