Providence RX Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PROVIDENCE RX INC

Practice address

7302 S Yale Ave Ste 101
Tulsa, OK 74136-7032

Phone

(918) 392-3366

Fax

(918) 392-2950

NPI assigned

Aug 20, 2018

Organization subpart

No

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

Authorized official

Name

Lisa Aileen Owens, DPHNPI 1366517575

Title

President

Phone

(918) 808-6228

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Providence RX Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa Aileen Owens, DPH

  • Pharmacist
  • Tulsa, OK
  • NPI 1366517575
  NPD Authorized official

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

{
    "created_epoch": "1534723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646352000000",
    "number": "1225518079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7302 S YALE AVE STE 101",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741367032",
            "telephone_number": "918-808-6228",
            "fax_number": "918-392-2950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7302 S YALE AVE STE 101",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741367032",
            "telephone_number": "918-392-3366",
            "fax_number": "918-392-2950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE RX INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-20",
        "last_updated": "2022-03-04",
        "certification_date": "2022-03-04",
        "status": "A",
        "authorized_official_last_name": "OWENS",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "AILEEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "918-808-6228",
        "authorized_official_credential": "DPH"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200785950A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence RX Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Monica A Provenzano
• Providence Counseling and Consulting LLC
• Providence Excel Home Care
• Providence MRI Associates
• Providence Radiology
• Providentia LLC
• Providentia LLC
• Providentia LLC
• Derrick Wayne Pruitt, MEDICAL STUDENT
• Joseph Edward Pruitt, PA-C

• Community/Retail Pharmacy in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Community/Retail Pharmacy in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.