Healthcare Provider Details

I. General information

NPI: 1386103190
Provider Name (Legal Business Name): AUSTIN WAYNE CRISSMAN PHARM.D, MBA, BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
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 TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number18919
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code1835C0207X
TaxonomyCompounded Sterile Preparations Pharmacist
License Number18919
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: