Provider Demographics
NPI:1871675124
Name:TOTALDOSE CHICKASHA LLC
Entity type:Organization
Organization Name:TOTALDOSE CHICKASHA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, PHD
Authorized Official - Phone:580-284-7896
Mailing Address - Street 1:14101 N EASTERN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5860
Mailing Address - Country:US
Mailing Address - Phone:580-284-7896
Mailing Address - Fax:
Practice Address - Street 1:2103 W IOWA AVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-2737
Practice Address - Country:US
Practice Address - Phone:405-222-2273
Practice Address - Fax:405-222-2546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2076449OtherPK
OK100247460AMedicaid
OK100247460BMedicaid
OK100247460AMedicaid
OK185702OtherSTATE LICENSE