Provider Demographics
NPI:1679880512
Name:OKEY PHARMACY LLC
Entity type:Organization
Organization Name:OKEY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOKOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:405-232-0529
Mailing Address - Street 1:1515 N CLASSEN BLVD
Mailing Address - Street 2:STE. 101
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-6611
Mailing Address - Country:US
Mailing Address - Phone:405-604-9085
Mailing Address - Fax:405-604-9122
Practice Address - Street 1:1515 N CLASSEN BLVD
Practice Address - Street 2:STE. 101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6611
Practice Address - Country:US
Practice Address - Phone:405-604-9085
Practice Address - Fax:405-604-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK156013336C0003X, 3336C0003X
3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200315480AMedicaid
2127371OtherPK