Integris Pharmacy 4188
LBN: Integris Prohealth Inc
Integris Pharmacy 4188 is an health care organization with primary practice located at 5915 W Memorial Rd Ste 110 , Oklahoma City OK 73142-2022. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Community/Retail Pharmacy, Suppliers / Specialty Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
Integris Prohealth Inc can be contacted via phone (405) 773-2300, or through Wallace, Donna M via phone (636) 359-4890.
Contact Information
Primary practice address
5915 W Memorial Rd Ste 110
Oklahoma City OK 73142-2022
Phone: (405) 773-2300
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Community/Retail Pharmacy | 3336C0003X | 1-6900 | Oklahoma |
| Suppliers / Specialty Pharmacy | 3336S0011X |
Profile Details
| NPI number | 1588992861 |
|---|---|
| LBN Legal business name | Integris Prohealth Inc |
| DBA Doing business as | Integris Pharmacy 4188 |
| Authorized official | Wallace, Donna M |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Nov 25th, 2009 |
| Last updated | May 6th, 2024 - about last year |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1588992861 | NPPES |
| Oklahoma | MEDICAID | 100239970E | |
| Oklahoma | MEDICAID | 100239970C | |
| Oklahoma | Other | 2121523 |
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