Provider Demographics
NPI:1366945842
Name:PHARMORE SPECIALTY PHARMACIES LLC
Entity type:Organization
Organization Name:PHARMORE SPECIALTY PHARMACIES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPHT
Authorized Official - Phone:405-210-1799
Mailing Address - Street 1:3330 NW 56TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4426
Mailing Address - Country:US
Mailing Address - Phone:405-604-6861
Mailing Address - Fax:405-605-3588
Practice Address - Street 1:3330 NW 56TH ST STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4426
Practice Address - Country:US
Practice Address - Phone:405-604-6861
Practice Address - Fax:405-605-3588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1-8154OtherOKLAHOMA STATE BOARD OF PHARMACY
OK200768080AMedicaid