Healthcare Provider Details

I. General information

NPI: 1225142201
Provider Name (Legal Business Name): PREFERRED PHCY PROVIDERS OF SE OK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E COURT ST
ATOKA OK
74525-2032
US

IV. Provider business mailing address

116 E COURT ST
ATOKA OK
74525-2032
US

V. Phone/Fax

Practice location:
  • Phone: 580-889-9191
  • Fax: 580-889-9194
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number574826
License Number StateOK

VIII. Authorized Official

Name: TONY HOUFF
Title or Position: PRES
Credential: DPH
Phone: 580-889-9191