Abdul-Rahman Al-Jarrah
Individual provider Active NPI Pharmacist · Moore, OK
NPI 1700505690 · NPPES record last updated Aug 24, 2022
Key facts
- NPI
- 1700505690
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 16780 (OK)
- Practice address
- 800 SE 4TH St
Moore, OK 73160-7210 - Phone
- (405) 794-1539
- NPI assigned
- Aug 24, 2022
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16780 | OK | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oklahoma CVS Pharmacy LLC | Past |
Accepting new patients | |
| Oklahoma CVS Pharmacy LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 16780 | OK | Yes |
Addresses
Primary practice location
800 SE 4TH St
Moore, OK 73160-7210
Mailing address
10235 Kingston Way
Village, OK 73120-2083
Phone (405) 902-1565
Other providers in Moore, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 24, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.