Healthcare Provider Details

I. General information

NPI: 1891804035
Provider Name (Legal Business Name): JIM C PRITCHARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 PLAZA CT
SAND SPRINGS OK
74063-7915
US

IV. Provider business mailing address

205 RAWSON RD
SAND SPRINGS OK
74063-4008
US

V. Phone/Fax

Practice location:
  • Phone: 918-245-9696
  • Fax: 918-245-5906
Mailing address:
  • Phone: 918-245-7764
  • Fax: 918-245-5906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9015
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: