Healthcare Provider Details

I. General information

NPI: 1669558201
Provider Name (Legal Business Name): SAM F THORNBROUGH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N. WATTS ST.
SAYRE OK
73662
US

IV. Provider business mailing address

PO BOX 99
SAYRE OK
73662-0099
US

V. Phone/Fax

Practice location:
  • Phone: 580-928-3058
  • Fax: 580-928-3873
Mailing address:
  • Phone: 580-928-3058
  • Fax: 580-928-3873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7537
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: