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General NPI Number Information
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NPI Number | 1487675443
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Entity Type | Organization
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Legal Business Name | SIMPSONS PRAGUE PHARMACY PLLC
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 1020 W MAIN ST
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City | PRAGUE
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State | OK
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Zip | 74864-4501
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Country | US
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Telephone | 405-567-4322
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Fax | 405-567-3303
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Provider Business Mailing Address
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Address Line | 1020 W MAIN ST
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City | PRAGUE
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State | OK
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Zip | 74864-4501
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Country | US
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Telephone | 405-567-4322
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Fax | 405-567-3303
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Authorized Official
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Title or Position | OWNER
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Name | GERRY SIMPSON
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Credential | D PH
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Telephone | 405-567-4322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 31-5953
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License Number State | OK
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