Active NPI
Andrea J Self, DPH
- Pharmacist
- Muldrow, OK
National Provider Identifier
1720206576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12140
- Practice address
- 710 E Shawntell Smith Blvd
Muldrow, OK 74948 - Phone
- (918) 427-3243
- Fax
- (918) 427-6678
- NPI assigned
- Apr 24, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 12140 | OK | Primary |
Addresses
Primary practice location
710 E Shawntell Smith Blvd
Muldrow, OK 74948
Mailing address
PO Box 1109
Muldrow, OK 74948-1109
Phone (918) 427-3243
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 |
|---|---|---|---|
| 12140 | OK | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Muldrow Pharmacy Inc. | Current | Accepting new patients | |
| Muldrow Pharmacy Inc. | Current | Accepting new patients | |
| Williams Family Pharmacy, Inc. | Past | Accepting new patients |
Locations
710 E Shawntel Smith Blvd
Muldrow, OK 74948
Phone (918) 427-3242
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Muldrow, OK
- NPI 1447320502
-
- Durable Medical Equipment & Medical Supplies
- Muldrow, OK
- NPI 1558580316
-
- Community/Retail Pharmacy
- Muldrow, OK
- NPI 1962928358
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720206576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1109",
"city": "MULDROW",
"state": "OK",
"postal_code": "749481109",
"telephone_number": "918-427-3243",
"fax_number": "918-427-6678"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "710 E SHAWNTELL SMITH BLVD",
"city": "MULDROW",
"state": "OK",
"postal_code": "74948",
"telephone_number": "918-427-3243",
"fax_number": "918-427-6678"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SELF",
"first_name": "ANDREA",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "12140",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Muldrow, OK
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.