Provider Demographics
NPI:1831759679
Name:OLIVERS EXPRESS PHARMACY LLC
Entity type:Organization
Organization Name:OLIVERS EXPRESS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:LACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:580-227-4000
Mailing Address - Street 1:624 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73737-1216
Mailing Address - Country:US
Mailing Address - Phone:580-227-4000
Mailing Address - Fax:
Practice Address - Street 1:624 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OK
Practice Address - Zip Code:73737-1216
Practice Address - Country:US
Practice Address - Phone:580-227-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLIVER'S EXPRESS PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1225OtherHEARING AID DEALER AND FITTER