NPIMap

Organization Active NPI

23Rd Street Pharmacy LLC

  • Community/Retail Pharmacy
  • Oklahoma City, OK
National Provider Identifier
1215202064
Registry record updated Jun 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
16693 Issued in OK
Legal business name
23RD STREET PHARMACY LLC
Practice address
2316 NW 23Rd St
Oklahoma City, OK 73107-2406
Phone
(405) 602-6442
Fax
(405) 602-6449
NPI assigned
Mar 13, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mickey Phan
Title
Owner
Phone
(405) 513-0710

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 16693 OK Primary
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

2316 NW 23Rd St
Oklahoma City, OK 73107-2406

Mailing address

2316 NW 23Rd St
Oklahoma City, OK 73107-2406
Phone (405) 602-6442

Other identifiers 1

IdentifierTypeStateIssuer
2133976OtherPK

Other names 1

  • 23rd Street Pharmacy Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466035200000",
    "number": "1215202064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2316 NW 23RD ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731072406",
            "telephone_number": "405-602-6442",
            "fax_number": "405-602-6449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2316 NW 23RD ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731072406",
            "telephone_number": "405-602-6442",
            "fax_number": "405-602-6449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "23RD STREET PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-13",
        "last_updated": "2016-06-16",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "MICKEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-513-0710"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OK",
            "license": "16693",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2133976",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "23rd Street Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.