PROVIDENTIA LLC (NPI# 1710910237) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710910237 |
| Entity Type | Organization |
| Organization Name | PROVIDENTIA LLC |
| Other Organization Name | FREELAND BROWN PHARMACY |
| Practice Address |
4112 S Peoria Ave Tulsa OK 74105-7613 |
| Practice Telephone | 9187434491 |
| Practice Fax Number | 9187435432 |
| Mailing Telephone | 9187434491 |
| Mailing Fax Number | 9187435432 |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2020-07-28 |
| Authorized Official Name | ANDREW AARON KOHLER (OWNER/MANAGER) |
| Authorized Official Telephone | 9187434491 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 333600000X | Pharmacy | Suppliers | ||
| N | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
2-5706 | OK | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100232760 A | 05 | |
| OK | 100232760 B | 05 | |
| PK | 2130880 | 01 |
| Other Name | Type Code |
|---|---|
| Freeland Brown Pharmacy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295101632 | Providentia LLC | Durable Medical Equipment & Medical Supplies | 4227 Southwest Blvd, Crystal City Shopping Center, Tulsa, OK 74107-6522 | 2015-08-20 |
| 1700965472 | Providentia LLC | Pharmacy | 1507 W 51st St, Tulsa, OK 74107-8041 | 2006-11-03 |
| Street Address |
4112 S PEORIA AVE |
| City | TULSA |
| State | OK |
| Zip Code | 74105-7613 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821427428 | Matthew Corgill | Pharmacy Technician | 4112 S Peoria Ave, Tulsa, OK 74105-7613 | 2013-11-04 |
| 1558617092 | Samuel Corey Flegal | Pharmacist | 4112 S Peoria Ave, Tulsa, OK 74105-7613 | 2012-08-02 |
| 1750637195 | Stephen Robert Strong | Pharmacist | 4112 S Peoria Ave, Tulsa, OK 74105-7613 | 2012-08-02 |
| 1265750905 | Lawrence Levern Lofstrom | Pharmacist | 4112 S Peoria Ave, Tulsa, OK 74105-7613 | 2010-05-05 |
| 1821327057 | Michael Aaron Dotson | Pharmacist | 4112 S Peoria Ave, Tulsa, OK 74105-7613 | 2009-12-17 |
| 1922173160 | James Maurice Brown | Pharmacist | 4112 S Peoria Ave, Tulsa, OK 74105-7613 | 2006-11-22 |
| 1447262787 | Dennis Edward Dufour | Pharmacist | 4112 S Peoria Ave, Tulsa, OK 74105-7613 | 2006-08-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881208817 | Op Pharmacy LLC | Pharmacy | 2865 E. Skelly Dr., Ste 225, Tulsa, OK 74105 | 2020-09-08 |
| 1114560554 | Secure Interpretation, LLC | Neurological Surgery | 5561 South Lewis Ave, Tulsa, OK 74105 | 2019-10-17 |
| 1629547286 | Kealey Jordan Oliver | Occupational Therapist | 3223 E. 31st Steet, Tulsa, OK 74105 | 2018-11-13 |
| 1265915631 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 3516 S Peoria Ave, Tulsa, OK 74105 | 2018-09-12 |
| 1235635277 | Brenda Kay Sanders | Speech-Language Pathologist | 4911 S Detroit Ave, Tulsa, OK 74105 | 2018-03-30 |
| 1417400771 | Caroline Hunter Heineck | Speech-Language Pathologist | 3223 E. 31st St., Tulsa, OK 74105 | 2016-08-03 |
| 1437509544 | Reliance Care Health Services LLP | Home Health | 5810 S. Peoria Avenue, Tulsa, OK 74105 | 2016-06-20 |
| 1578921748 | Latisha Henderson | Case Manager/Care Coordinator | 3015 E. Skelly Drive, Suite 103, Tulsa, OK 74105 | 2016-02-03 |
| 1326424573 | Evelyn J Fennell | Nurse's Aide | 1143 E 57th Place, Tulsa, OK 74105 | 2015-08-10 |
| 1255717757 | Rebecca Ann Hughes | Dentist | 3150 E 41st St Ste 131, Tulsa, OK 74105 | 2015-08-06 |
| Find all providers in zip 74105 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962063933 | Walgreen Co | Pharmacy | 1145 S Utica Ave Ste G1, Tulsa, OK 74104-4022 | 2019-06-21 |
| 1952888356 | Genscripts LLC | Pharmacy | 10827 S Memorial Dr Ste D, Tulsa, OK 74133-7361 | 2018-07-27 |
| 1063824589 | Rx Holdings LLC | Pharmacy | 11414 E 51st St Ste A, Tulsa, OK 74146-5800 | 2014-06-02 |
| 1508102609 | Insync Life Care LLC | Pharmacy | 6310 East 102nd Street, Tulsa, OK 74137-7061 | 2012-12-17 |
| 1235315250 | Oklahoma Cvs Pharmacy LLC | Pharmacy | 7437 S Olympia Ave W, Tulsa, OK 74132-1838 | 2008-01-22 |
| 1366526022 | Walgreen Co | Pharmacy | 5046 S Sheridan Rd, Tulsa, OK 74145-5714 | 2006-10-25 |
| 1225121338 | Moore Pharmacy Service; LLC | Pharmacy | 11414 E. 51st Street, Unit A, Tulsa, OK 74146-5821 | 2006-10-02 |
| 1134233117 | Genscripts LLC | Pharmacy | 3980 S Hudson Ave, Tulsa, OK 74135-5608 | 2006-08-18 |
| 1699786723 | Cfp Acquisitions, Inc. | Pharmacy | 6136 E 51st St, Tulsa, OK 74135-7704 | 2006-08-11 |
| 1033126925 | Walgreen Co | Pharmacy | 10018 S Yale Ave, Tulsa, OK 74137-6016 | 2006-08-02 |
| Find all providers in TULSA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.