Healthcare Provider Details

I. General information

NPI: 1477458545
Provider Name (Legal Business Name): ZACHARY WILLIAM BRACK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N CLARENCE NASH BLVD
WATONGA OK
73772-4250
US

IV. Provider business mailing address

101 N CLARENCE NASH BLVD
WATONGA OK
73772-4250
US

V. Phone/Fax

Practice location:
  • Phone: 580-623-4545
  • Fax: 580-623-4549
Mailing address:
  • Phone: 580-623-4545
  • Fax: 580-623-4549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13405
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: