Provider Demographics
NPI:1548872369
Name:APEX PHARMACY LLC
Entity type:Organization
Organization Name:APEX PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:DECKARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:405-426-0290
Mailing Address - Street 1:4400 GRANT BLVD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-0037
Mailing Address - Country:US
Mailing Address - Phone:405-577-6775
Mailing Address - Fax:844-908-1423
Practice Address - Street 1:4400 GRANT BLVD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-0037
Practice Address - Country:US
Practice Address - Phone:405-577-6775
Practice Address - Fax:405-577-6776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-21
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200925650AMedicaid