Prairie Gardens Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PRAIRIE GARDENS PHARMACY INC

Practice address

12301 N Western Ave Ste 106
Oklahoma City, OK 73114-8017

Phone

(405) 768-1818

Fax

(405) 768-1919

NPI assigned

May 20, 2022

Organization subpart

No

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

Authorized official

Name

Troy Simons, PHARMD

Title

President

Phone

(405) 742-8099

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OK2 enrollments

Enrollment records 2

Tax ID family

Prairie Gardens Pharmacy Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Prairie Gardens Pharmacy LTC Inc

  • Long Term Care Pharmacy
  • Oklahoma City, OK
  • NPI 1346988565
  NPD tax ID

Locations

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

{
    "created_epoch": "1653004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669161600000",
    "number": "1083352066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 S WALNUT ST",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740744225",
            "telephone_number": "405-768-1818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12301 N WESTERN AVE STE 106",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731148017",
            "telephone_number": "405-768-1818",
            "fax_number": "405-768-1919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE GARDENS PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-20",
        "last_updated": "2022-11-23",
        "certification_date": "2022-11-23",
        "status": "A",
        "authorized_official_last_name": "SIMONS",
        "authorized_official_first_name": "TROY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "405-742-8099",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OKLAHOMA STATE BOARD OF PHARMACY",
            "identifier": "1-9220",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.prairiegardenspharmacy.com",
            "affiliation": "N",
            "endpointDescription": "url",
            "address_1": "12301 N Western Ave Ste 106",
            "city": "Oklahoma City",
            "state": "OK",
            "country_code": "US",
            "postal_code": "731148017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Schuyler Allison Pracht, DDS
• Aziz Pradhan
• Armando Prado, BHRS
• Prairie Gardens Medical LLC
• Prairie Gardens Medical LLC
• Prairie Gardens Pharmacy LTC Inc
• Prairie View Healthcare, Inc. (Excell Hospice)
• Prairie View Healthcare, Inc. (Excell Home Care)
• Rani Praizner
• Niraj Kishore Prasad, MD

• Community/Retail Pharmacy in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Community/Retail Pharmacy in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2022; 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.