Guardian Pharmacy of Oklahoma LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

487429 Issued in OK

Legal business name

GUARDIAN PHARMACY OF OKLAHOMA LLC

Doing business as

Boomer Solutions

Practice address

310 S 1St St
Eufaula, OK 74432-3202

Phone

(877) 774-3706

Fax

(888) 852-2946

NPI assigned

Oct 7, 2015

Last updated

Sep 19, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kyle SimmonsNPI 1609173558

Title

Co-President

Phone

(877) 774-3706

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• Boomer Solutions Doing business as

Medicare fee-for-service enrollment

Enrolled in OK2 enrollments

Enrollment records 2

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Guardian Pharmacy of Tulsa, LLC

  dba Boomer Solutions of Tulsa

  • Long Term Care Pharmacy
  • Tulsa, OK
  • NPI 1194185504

  O20151208002458

  Same enrollment

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kyle Matthew Simmons, PHARM D.

  • Pharmacist
  • Eufaula, OK
  • NPI 1609173558
  Authorized official Same address or phone

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

{
    "created_epoch": "1444176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758240000000",
    "number": "1083084768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11407",
            "address_2": "DEPT # 2610",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352462610",
            "telephone_number": "404-810-0089",
            "fax_number": "404-810-0094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 S 1ST ST",
            "city": "EUFAULA",
            "state": "OK",
            "postal_code": "744323202",
            "telephone_number": "877-774-3706",
            "fax_number": "888-852-2946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN PHARMACY OF OKLAHOMA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-07",
        "last_updated": "2025-09-19",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "CO-PRESIDENT",
        "authorized_official_telephone_number": "877-774-3706"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "OK",
            "license": "487429",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200611770A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2154687",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boomer Solutions",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katrina Jo Goforth, B.S
• Lisa Gray, APRN
• Green Country Behavioral Health Services, Inc.
• Green Country Behavioral Health Services, Inc.
• Guardian Health Systems Eufaula
• Kathryn Marie Ham
• Dylan Hays
• Health Management Services, Inc. (Health Management Rehab)
• Tracy Heatley
• Baylee Marie Heflin

• Long Term Care Pharmacy in Eufaula, OK
• Providers in Eufaula, OK by specialty
• Long Term Care Pharmacy in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.