Providentia Llc
Community/Retail Pharmacy
4112 S Peoria Ave, Tulsa
Oklahoma, 74105-7613
918-743-4491 918-743-5432
Providentia Llc is a Community/Retail Pharmacy in Tulsa, Oklahoma. It is located at 4112 S Peoria Ave, Tulsa and it's customer support contact number is 918-743-4491. The authorized person of Providentia Llc is Andrew Aaron Kohler who is Owner/manager of the pharmacy and his contact number is 918-743-4491. Active license number of Providentia Llc is 2-5706 for Community/Retail Pharmacy in Oklahoma. Providentia Llc accepts medicare which means medicare covered patients will not be billed for any more than the Medicare deductible and coinsurance.
Providentia Llc is 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.
Pharmacy Details:
Providentia Llc type, location, contact phone number and fax are as below. Patients can directly walkin to the pharmacy or can call on the below given customer support phone number for enquiries.
| Name: | Providentia Llc |
| Type: | Community/Retail Pharmacy |
| Location: | 4112 S Peoria Ave, Tulsa,
Oklahoma, 74105-7613 |
| Phone: | 918-743-4491 |
| Fax: | 918-743-5432 |
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints of this pharmacy is as below. Person's position and contact details are also mentioned below.
| Name: | Andrew Aaron Kohler |
| Position: | Owner/manager |
| Contact Number: | 918-743-4491 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details of given pharmacy are as mentioned below.
| NPI Number: | 1710910237 |
| NPI Enumeration Date: | 08 Jul, 2006 |
| NPI Last Update On: | 28 Jul, 2020 |
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Providentia Llc are as mentioned below.
| Specialization | License Number | State | Status | |
| Community/Retail Pharmacy | 2-5706 | Oklahoma | Primary | |
| Durable Medical Equipment & Medical Supplies | | | Secondary | |
| Pharmacy | | | Secondary | |
| Long Term Care Pharmacy | | | Secondary | |
Other Medical Identifiers:
Other legacy medical identifiers of the pharmacy such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 100232760 B | Medicaid | Oklahoma | |
| 100232760 A | Medicaid | Oklahoma | |
| 2130880 | Other | | Pk |
Medicare Enrollment:
Providentia Llc is enrolled in medicare and it's Pac Id, enrollment Id, registered name and type is as stated below.
| PAC ID: |
Enrollment ID: |
Org Name | Medicare Entity Type |
| 8123298833 | O20110906000628 | Providentia, Llc | DME SUPPLIER - PHARMACY |
| 8123298833 | O20120920000234 | Providentia, Llc | PART B SUPPLIER - MASS IMMUNIZATION (ROSTER BILLER ONLY) |
Products Available:
Providentia Llc has following products available for sale under medicare.
| Products: |
|---|
| • Blood Glucose Monitors & Supplies: Mail Order | • Blood Glucose Monitors & Supplies: Non-mail Order |
| • Canes & Crutches | • Commodes, Urinals, & Bedpans |
| • Diabetic Shoes & Inserts: Custom Fabricated | • Diabetic Shoes & Inserts: Prefabricated |
| • Enteral Equipment And/or Supplies | • Enteral Nutrients |
| • Heat & Cold Applications | • Hospital Beds: Electric |
| • Hospital Beds: Manual | • Nebulizer Equipment & Supplies |
| • Orthoses: Off-the-shelf | • Orthoses: Prefabricated |
| • Ostomy Supplies | • Patient Lifts |
| • Power Operated Vehicles (scooters) | • Seat Lift Mechanisms |
| • Support Surfaces: Pressure Reducing Beds, Mattresses, Overlays, & Pads | • Surgical Dressings |
| • Transcutaneous Electrical Nerve Stimulators (tens) Units | • Urological Supplies |
| • Walkers | • Wheelchair Seating/cushions |
| • Wheelchairs & Accessories: Standard Manual | • Wheelchairs & Accessories: Standard Power |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | 4112 S Peoria Ave,
Tulsa, Oklahoma |
| Zip: | 74105-7613 |
| Phone Number: | 918-743-4491 |
| Fax Number: | 918-743-5432 |
Patients can reach Providentia Llc at
4112 S Peoria Ave, Tulsa, Oklahoma or can
call on customer care at 918-743-4491.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 08 December, 2025.