Provider Demographics
NPI:1992107577
Name:THE GEORGE PROTHRO, MD PHARMACY OF TULSA COUNTY
Entity type:Organization
Organization Name:THE GEORGE PROTHRO, MD PHARMACY OF TULSA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-596-5010
Mailing Address - Street 1:2401 CHARLES PAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-8435
Mailing Address - Country:US
Mailing Address - Phone:918-596-5575
Mailing Address - Fax:918-596-5562
Practice Address - Street 1:2401 CHARLES PAGE BLVD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-8435
Practice Address - Country:US
Practice Address - Phone:918-596-5575
Practice Address - Fax:918-596-5562
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TULSA COUNTY BOARD OF COUNTY COMMISSIONERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty