Provider Demographics
NPI:1215671151
Name:BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA DBA 1893 PHARMACY
Entity type:Organization
Organization Name:BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA DBA 1893 PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY (JAY)
Authorized Official - Middle Name:W
Authorized Official - Last Name:KINNARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:405-550-5315
Mailing Address - Street 1:1110 N STONEWALL AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-1200
Mailing Address - Country:US
Mailing Address - Phone:405-550-5315
Mailing Address - Fax:405-271-6446
Practice Address - Street 1:901 N STONEWALL AVE STE 1200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1218
Practice Address - Country:US
Practice Address - Phone:405-271-8931
Practice Address - Fax:405-271-8938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy