Provider Demographics
NPI:1316982531
Name:PHARMACY CONSULTANT SERVICES INC
Entity type:Organization
Organization Name:PHARMACY CONSULTANT SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:405-527-2107
Mailing Address - Street 1:1300 N GREEN AVE
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-1807
Mailing Address - Country:US
Mailing Address - Phone:405-527-2107
Mailing Address - Fax:405-527-5399
Practice Address - Street 1:1300 N GREEN AVE
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-1807
Practice Address - Country:US
Practice Address - Phone:405-527-2107
Practice Address - Fax:405-527-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X, 3336M0002X, 3336C0004X, 332B00000X, 333600000X
OK4762113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100234160CMedicaid
2073467OtherPK
OK100234160AMedicaid
OK100234160AMedicaid