Active NPI
Penny D Southern, DPH
- Pharmacist
- Shawnee, OK
National Provider Identifier
1659307460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 10652
- Practice address
- 2307 S Gordon Cooper Dr
Shawnee, OK 74801-9007 - Phone
- (405) 273-5236
- Fax
- (405) 273-2392
- NPI assigned
- Jun 23, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 10652 | OK | Primary |
Addresses
Primary practice location
2307 S Gordon Cooper Dr
Shawnee, OK 74801-9007
Mailing address
2307 S Gordon Cooper Dr
Shawnee, OK 74801-9007
Phone (405) 273-5236
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10652 | Other | OK | STATE BOARD OF PHARMACY # |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 10652 | OK | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1659307460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2307 S GORDON COOPER DR",
"city": "SHAWNEE",
"state": "OK",
"postal_code": "748019007",
"telephone_number": "405-273-5236",
"fax_number": "405-273-2392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2307 S GORDON COOPER DR",
"city": "SHAWNEE",
"state": "OK",
"postal_code": "748019007",
"telephone_number": "405-273-5236",
"fax_number": "405-273-2392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUTHERN",
"first_name": "PENNY",
"middle_name": "D",
"credential": "DPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "10652",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE BOARD OF PHARMACY #",
"identifier": "10652",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shawnee, OK
- John Soap Jr.
- Solara Hospital Shawnee, LLC (Cornerstone Specialty Hospitals Shawnee)
- Patricia Rose Solomon, R.D.H.
- Andrew Somers, PT, DPT
- South Central Industries, Inc
- Logan McHael Southwell
- Southwest Orthopaedic Specialists, PLLC
- Olivia Hazel Sowards
- Darin Craig Sparkman, MD
- Kendra Ann Speight, ARNP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.