Provider Demographics
NPI:1871771436
Name:KRISTI SUE PRESLEY
Entity type:Organization
Organization Name:KRISTI SUE PRESLEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:PIOWATY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:918-827-6301
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:MOUNDS
Mailing Address - State:OK
Mailing Address - Zip Code:74047-0032
Mailing Address - Country:US
Mailing Address - Phone:918-827-6301
Mailing Address - Fax:918-827-6296
Practice Address - Street 1:1419 COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:MOUNDS
Practice Address - State:OK
Practice Address - Zip Code:74047
Practice Address - Country:US
Practice Address - Phone:918-827-6301
Practice Address - Fax:918-827-6296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11-51023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2074765OtherPK
OK100243110BMedicaid
OK100243110AMedicaid
OK100243110AMedicaid