Healthcare Provider Details

I. General information

NPI: 1417871377
Provider Name (Legal Business Name): CRISSMAN PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 W ROCK CREEK RD STE 120
NORMAN OK
73072-2466
US

IV. Provider business mailing address

3411 W ROCK CREEK RD STE 120
NORMAN OK
73072-2466
US

V. Phone/Fax

Practice location:
  • Phone: 572-229-4676
  • Fax: 572-229-8171
Mailing address:
  • Phone: 572-229-4676
  • Fax: 572-229-8171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AUSTIN CRISSMAN
Title or Position: OWNER
Credential:
Phone: 572-229-4676