Healthcare Provider Details

I. General information

NPI: 1083741383
Provider Name (Legal Business Name): TROY SIMONS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 N 6TH ST
PERRY OK
73077-6607
US

IV. Provider business mailing address

616 N ROCK CT
STILLWATER OK
74075-8817
US

V. Phone/Fax

Practice location:
  • Phone: 580-336-2136
  • Fax: 580-336-9445
Mailing address:
  • Phone: 405-372-4882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12299
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: