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Contact Information

OKLAHOMA CVS PHARMACY LLC
4500 N KICKAPOO AVE
SHAWNEE, OK74804-1208
 Phone: 405-878-0244
 Fax: 405-878-0432
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
 

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
Indicates primary specialty

NPI Profile & details for OKLAHOMA CVS PHARMACY LLC

NPI Number 1588768311
LBN Legal business name OKLAHOMA CVS PHARMACY LLC
Authorized official SUSAN COLBERT - (DIRECTOR, PAYER RELATIONS)
Entity Organization
Organization subpart 1 No
Enumeration date 09/12/2006
Last updated 01/17/2023 - About 3 years ago
Identifiers
OK License # 10-5261
OK Medicaid 90003921095
Other 3715577 OTHER ID NUMBER-COMMERCIAL NUMBER
OK Other 100239430B STATE MEDICAID DME NUMBER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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