Organization

Providentia Llc

May also be knows as Freeland Brown Pharmacy No. 3

Community/Retail Pharmacy in Tulsa, OK(View on Map)

Legal Business Name

Providentia Llc

Also Known As

Freeland Brown Pharmacy No. 3

NPI Number

1295101632

NPI Type

Organization

Enumeration Date

08/20/2015

Specialties

(Taxonomies)

Code

3336C0003X
332B00000X
3336L0003X
333600000X

Primary Taxonomy

Yes
No
No
No

Licenses

State

Arkansas
Oklahoma

License Number

PD07681
2-7324

Contact
Information

Purpose

Mailing
Location

Address

4112 S PEORIA AVE
4227 SOUTHWEST BLVD

City

Tulsa
Tulsa

State

OK
OK

Postal Code

74105-7613
74107-6522

Country

US
US

Telephone Number

(918) 743-4491
(918) 986-8644

Authorized Official

Name

Andrew Kohler

Title or Position

PRINCIPAL

Telephone Number

(918) 743-4491

Identifiers

Identifier

100232760 F
2153603

Identifier State

OK
Unknown

Identifier Issuer

Unknown
PK

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 07/28/2020

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