Integris Pharmacy 4188

LBN: Integris Prohealth Inc
Integris Pharmacy 4188 is an health care organization with primary practice located at 5915 W Memorial Rd Ste 110 , Oklahoma City OK 73142-2022. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Community/Retail Pharmacy, Suppliers / Specialty Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Integris Prohealth Inc can be contacted via phone (405) 773-2300, or through Wallace, Donna M via phone (636) 359-4890.

Contact Information

Primary practice address
5915 W Memorial Rd Ste 110 Oklahoma City OK 73142-2022
Fax:
Website:
Authorized official contact:
Name: Wallace, Donna M

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Community/Retail Pharmacy 3336C0003X 1-6900 Oklahoma
Suppliers / Specialty Pharmacy 3336S0011X

Profile Details

NPI number 1588992861
LBN Legal business name Integris Prohealth Inc
DBA Doing business as Integris Pharmacy 4188
Authorized official Wallace, Donna M
Entity Organization
Organization subpart 1 No
Enumeration date Nov 25th, 2009
Last updated May 6th, 2024 - about 4 months ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1588992861 NPPES
Oklahoma MEDICAID 100239970E
Oklahoma MEDICAID 100239970C
Oklahoma Other 2121523

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