Provider Demographics
NPI:1871053538
Name:PSOK PHARMACY INC
Entity type:Organization
Organization Name:PSOK PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-542-4444
Mailing Address - Street 1:900 N PORTER AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6426
Mailing Address - Country:US
Mailing Address - Phone:405-364-5222
Mailing Address - Fax:405-364-7076
Practice Address - Street 1:900 N PORTER AVE STE 101
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6426
Practice Address - Country:US
Practice Address - Phone:405-364-5222
Practice Address - Fax:405-364-7076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200832650BMedicaid
OK7-8395OtherOKLAHOMA BOARD OF PHARMACY
3730480OtherNCPDP
OK15242286-05OtherST TAX PERMIT
OK200832650AMedicaid
OK64512OtherOBN
OK64512OtherOBN