Active NPI
Prairie Gardens Pharmacy LTC Inc
- Long Term Care Pharmacy
- Oklahoma City, OK
National Provider Identifier
1346988565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long Term Care Pharmacy
- Legal business name
- PRAIRIE GARDENS PHARMACY LTC 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 26, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Troy Simons, DPH
- Title
- President
- Phone
- (405) 742-8099
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Long Term Care Pharmacy | 3336L0003X | Primary |
Addresses
Primary practice location
12301 N Western Ave Ste 106
Oklahoma City, OK 73114-8017
Mailing address
824 S Walnut St
Stillwater, OK 74074-4225
Phone (918) 510-0648
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1-9220 | Other | OK | OKLAHOMA STATE BOARD OF PHARMACY |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | www.prairiegardenspharmacy.com |
National Provider Directory
National Provider Directory- Tax ID family
- Prairie Gardens Pharmacy Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Retail Pharmacy
- Oklahoma City, OK
- NPI 1083352066
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653523200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1668729600000",
"number": "1346988565",
"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": "918-510-0648"
},
{
"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 LTC INC",
"organizational_subpart": "NO",
"enumeration_date": "2022-05-26",
"last_updated": "2022-11-18",
"certification_date": "2022-11-18",
"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": "DPH"
},
"taxonomies": [
{
"code": "3336L0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Long Term Care 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": []
}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 Nov 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.