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General NPI Number Information
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NPI Number | 1134443492
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Entity Type | Individual
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Provider Name | JIMMY R. POFAHL
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Gender | Male
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Dates
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Enumeration Date | 03/16/2010
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Last Update Date | 03/16/2010
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Provider Practice Location Address
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Address Line | 501 SE WASHINGTON BLVD
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City | BARTLESVILLE
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State | OK
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Zip | 74006-8232
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Country | US
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Telephone | 918-333-9140
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Fax |
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Provider Business Mailing Address
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Address Line | 916 N 12TH ST
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City | COLLINSVILLE
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State | OK
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Zip | 74021-1821
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Country | US
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Telephone | 918-371-6710
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 8529
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License Number State | OK
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