Theracomprx LLC

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

23-6620 Issued in OK

Legal business name

THERACOMPRX LLC

Practice address

1414 Arlington St
Ste 2200
Ada, OK 74820-2646

Phone

(580) 436-9922

Fax

(580) 436-9919

NPI assigned

Mar 7, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Kenneth Wayne Bailes II, RPH, PHARMD

Title

Pharmacist-in-Charge/Owner

Phone

(580) 759-6238

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1394150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394150400000",
    "number": "1598181000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 ARLINGTON ST",
            "address_2": "STE 2200",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748202646",
            "telephone_number": "580-436-9922",
            "fax_number": "580-436-9919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 ARLINGTON ST",
            "address_2": "STE 2200",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748202646",
            "telephone_number": "580-436-9922",
            "fax_number": "580-436-9919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERACOMPRX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-07",
        "last_updated": "2014-03-07",
        "status": "A",
        "authorized_official_last_name": "BAILES",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "PHARMACIST-IN-CHARGE/OWNER",
        "authorized_official_telephone_number": "580-759-6238",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "RPH, PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "OK",
            "license": "23-6620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Compounding Pharmacy in Ada, OK
• Providers in Ada, OK by specialty
• Compounding Pharmacy in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2014; 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.