NPIMap

Individual provider Active NPI

Gregory N. Clyde, D.PH.

  • Pharmacist
  • Oklahoma City, OK
National Provider Identifier
1073579264
Registry record updated Oct 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
11937 Issued in OK
Practice address
9401 N Penn Ave
Oklahoma City, OK 73120-3914
Phone
(405) 751-3553
Fax
(405) 755-1056
NPI assigned
Apr 25, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 31, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 11937 OK Primary

Addresses

Primary practice location

9401 N Penn Ave
Oklahoma City, OK 73120-3914

Mailing address

9401 N Penn Ave
Oklahoma City, OK 73120-3914
Phone (405) 751-3553

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
11937OKMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
ZRC Pharmacy, LLC Current Accepting new patients
Oklahoma CVS Pharmacy LLC Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414713600000",
    "number": "1073579264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9401 N PENN AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731203914",
            "telephone_number": "405-751-3553",
            "fax_number": "405-755-1056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9401 N PENN AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731203914",
            "telephone_number": "405-751-3553",
            "fax_number": "405-755-1056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLYDE",
        "first_name": "GREGORY",
        "middle_name": "N.",
        "credential": "D.PH.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-25",
        "last_updated": "2014-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OK",
            "license": "11937",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.