Provider Demographics
NPI:1194818534
Name:PHARM NICHOLS HILLS ACQUISITION LLC
Entity type:Organization
Organization Name:PHARM NICHOLS HILLS ACQUISITION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:FINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-843-9501
Mailing Address - Street 1:7600 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:NICHOLS HILLS
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7016
Mailing Address - Country:US
Mailing Address - Phone:405-843-9501
Mailing Address - Fax:405-842-8535
Practice Address - Street 1:7600 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:NICHOLS HILLS
Practice Address - State:OK
Practice Address - Zip Code:73116-7016
Practice Address - Country:US
Practice Address - Phone:405-843-9501
Practice Address - Fax:405-842-8535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-75673336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100796470BMedicaid
2159751OtherPK