Healthcare Provider Details

I. General information

NPI: 1487675443
Provider Name (Legal Business Name): SIMPSONS PRAGUE PHARMACY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 W MAIN ST
PRAGUE OK
74864-4501
US

IV. Provider business mailing address

1020 W MAIN ST
PRAGUE OK
74864-4501
US

V. Phone/Fax

Practice location:
  • Phone: 405-567-4322
  • Fax: 405-567-3303
Mailing address:
  • Phone: 405-567-4322
  • Fax: 405-567-3303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number31-5953
License Number StateOK

VIII. Authorized Official

Name: GERRY SIMPSON
Title or Position: OWNER
Credential: D PH
Phone: 405-567-4322