MEDICARE: SOONER PHARMACY OF DAVIS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336L0003X	Long Term Care Pharmacy
4	3336C0003X	Community/Retail Pharmacy	55-4238	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2073930	OTHER		PK

General Provider Information

NPI Number	:	1083625628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOONER PHARMACY OF DAVIS INC

Provider Business Mailing Address
First Line	:	705 E MAIN ST
Second Line	:
City	:	DAVIS
State	:	OK
Zip	:	73030-1913
Country	:	US
Telephone Number	:	580-369-3776
Fax Number	:	580-369-2115

Provider Business Practice Location Address
First Line	:	705 E MAIN ST
Second Line	:
City	:	DAVIS
State	:	OK
Zip	:	73030-1913
Country	:	US
Telephone Number	:	580-369-3776
Fax Number	:	580-369-2115

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL LEE
Credential	:	RPH
Telephone Number	:	580-369-3776

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/02/2014

Similar Medicare Providers

1851433734 — MR. MICHAEL EUGENE LEE D.PH.
Practice Location Address:

705 E MAIN ST
DAVIS, OK
73030-1913

Practice Phone: 580-369-3776
Practice Fax: 580-369-2115

1497748180 — BURFORD MANOR
Practice Location Address:

505 S 7TH ST
DAVIS, OK
73030-3136

Practice Phone: 580-369-2369
Practice Fax: 580-369-2445

1891782884 — JANET MEINDERS CHARALAMPOUS R.D., L.D.10
Practice Location Address:

HC 67 BOX 1
DAVIS, OK
73030-9501

Practice Phone: 580-369-3636
Practice Fax: 580-369-3366

1538157102 — ROBERT RAYMOND HORANZY M.D.
Practice Location Address:

107 S 3RD ST
DAVIS, OK
73030-2305

Practice Phone: 580-369-2803
Practice Fax:

1164430336 — DR. JAMES PLESANT RHODES II D.C
Practice Location Address:

502 E. MAIN ST
DAVIS, OK
73030-1775

Practice Phone: 580-369-3600
Practice Fax: 580-369-3728

1619980265 — DR. HEIDI BROOKE WRIGHT PHARM.D
Practice Location Address:

218 E MAIN ST
DAVIS, OK
73030-1904

Practice Phone: 580-369-2831
Practice Fax: 580-369-2614

Directions to “SOONER PHARMACY OF DAVIS INC ” Practice Location

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