| Organization Name: | OLYMPIA PHARMACY LLC |
| NPI Number: | 1003076738 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHAWN CRISMON (PHARMACIST) |
| Mailing Address: | 6802 S Olympia Ave Ste 125 Tulsa |
| State: | OK US |
| Postal Code: | 741321823 |
| Phone Number: | 9183986279 |
| Fax Number: | |
| NPI Enumeration Date: | 06/16/2008 |
| NPI Last Update Date: | 02/20/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0004X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Compounding Pharmacy |
| Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |