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General NPI Number Information
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NPI Number | 1861485559
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Entity Type | Organization
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Legal Business Name | SOONER PHARMACY
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 815 W BROADWAY AVE
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City | SULPHUR
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State | OK
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Zip | 73086-4611
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Country | US
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Telephone | 580-622-2208
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Fax | 580-622-2200
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Provider Business Mailing Address
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Address Line | 815 W BROADWAY AVE
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City | SULPHUR
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State | OK
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Zip | 73086-4611
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Country | US
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Telephone | 580-622-2208
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Fax | 580-622-2200
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | DR. DAVID RAY PITTMAN
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Credential | PHARM D, PHD
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Telephone | 580-622-2208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 55-3551
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License Number State | OK
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