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General NPI Number Information
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NPI Number | 1639386188
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Entity Type | Individual
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Provider Name | GARY LYLE TIGERT PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 35 TIFFANY PLZ STE C
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City | ARDMORE
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State | OK
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Zip | 73401-2526
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Country | US
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Telephone | 580-223-1331
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Fax | 580-223-4194
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Provider Business Mailing Address
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Address Line | 307 WOODS LN
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City | ARDMORE
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State | OK
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Zip | 73401-1159
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Country | US
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Telephone | 580-223-1331
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Fax | 580-223-4194
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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 | 8073
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License Number State | OK
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