Basic Information
| Provider Information | |||||||||
| NPI: | 1528721834 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOARD OF REGENTS OF THE UNIV OF OKLA-STEPHENSON SPECIALTY PHARMACY | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 800 NE 10TH ST STE 3001 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731045418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052711515 | ||||||||
| FaxNumber: | 4052711001 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 NE 10TH ST STE 3001 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731045418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052711515 | ||||||||
| FaxNumber: | 4052711001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2021 | ||||||||
| LastUpdateDate: | 10/14/2021 | ||||||||
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| AuthorizedOfficialLastName: | ZUBIALDE | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | DEAN, PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4052711515 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | OU HEALTH PARTNERS, INC | ||||||||
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| NPICertificationDate: | 10/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.