Healthcare Provider Details

I. General information

NPI: 1174608467
Provider Name (Legal Business Name): TIGER DRUG COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 S WALNUT ST
STILLWATER OK
74074-4226
US

IV. Provider business mailing address

825 S WALNUT ST
STILLWATER OK
74074-4226
US

V. Phone/Fax

Practice location:
  • Phone: 405-372-7900
  • Fax: 405-377-5139
Mailing address:
  • Phone: 405-372-7900
  • Fax: 405-377-5139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8-6744
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TROY SIMONS
Title or Position: PRESIDENT
Credential:
Phone: 405-742-8099