Provider Demographics
NPI:1538219381
Name:EL RENO IHS PHARMACY
Entity type:Organization
Organization Name:EL RENO IHS PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OCA PHARMACY CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:KAILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SKIDGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-762-6611
Mailing Address - Street 1:1801 PARKVIEW
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 PARKVIEW
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2103
Practice Address - Country:US
Practice Address - Phone:405-259-1560
Practice Address - Fax:405-234-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
OK26-6688332800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100231960LMedicaid
2076216OtherPK