Provider Demographics
NPI:1396753786
Name:STEINHEIL PHARMACY SERVICES, LLC
Entity type:Organization
Organization Name:STEINHEIL PHARMACY SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:N
Authorized Official - Last Name:STEINHEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-485-2722
Mailing Address - Street 1:418 W CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-4608
Mailing Address - Country:US
Mailing Address - Phone:918-485-2722
Mailing Address - Fax:918-485-1702
Practice Address - Street 1:418 W CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-4608
Practice Address - Country:US
Practice Address - Phone:918-485-2722
Practice Address - Fax:918-485-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 333600000X, 3336L0003X
OK3875893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2129989OtherPK
OK200072390AMedicaid
OK200072390BMedicaid
OK200072390CMedicaid