MEDICARE: TIGER DRUG COMPANY

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	3336L0003X	Long Term Care Pharmacy
2	3336C0004X	Compounding Pharmacy
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	3336S0011X	Specialty Pharmacy
5	3336C0003X	Community/Retail Pharmacy	8-6744	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	2146057	OTHER		PK

General Provider Information

NPI Number	:	1174608467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIGER DRUG COMPANY

Provider Business Mailing Address
First Line	:	825 S WALNUT ST
Second Line	:
City	:	STILLWATER
State	:	OK
Zip	:	74074-4226
Country	:	US
Telephone Number	:	405-372-7900
Fax Number	:	405-377-5139

Provider Business Practice Location Address
First Line	:	825 S WALNUT ST
Second Line	:
City	:	STILLWATER
State	:	OK
Zip	:	74074-4226
Country	:	US
Telephone Number	:	405-372-7900
Fax Number	:	405-377-5139

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TROY SIMONS
Credential	:
Telephone Number	:	405-742-8099

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/02/2014

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Directions to “TIGER DRUG COMPANY ” Practice Location

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