| 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 |