David Derby, PHAMD
Individual provider Active NPI Pharmacist · Hominy, OK
NPI 1124417738 · NPPES record last updated Jan 20, 2015
Key facts
- NPI
- 1124417738
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 15238 (OK)
- Practice address
- 104 W Main St
Hominy, OK 74035-1032 - Phone
- (918) 885-2715
- NPI assigned
- Jan 20, 2015
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 15238 | OK | Yes |
Addresses
Primary practice location
104 W Main St
Hominy, OK 74035-1032
Mailing address
104 W Main St
Hominy, OK 74035-1032
Phone (918) 885-2715
Other providers in Hominy, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 20, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.