Sooner Pharmacy of Oklahoma LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

55-6470 Issued in OK

Legal business name

SOONER PHARMACY OF OKLAHOMA LLC

Practice address

815 W Broadway Ave
Sulphur, OK 73086-4611

Phone

(580) 622-2208

Fax

(580) 622-2212

NPI assigned

Nov 5, 2013

Last updated

Nov 5, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeremy Dewayne Hall

Title

Manager

Phone

(580) 622-2208

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1383609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383609600000",
    "number": "1861821399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 W BROADWAY AVE",
            "city": "SULPHUR",
            "state": "OK",
            "postal_code": "730864611",
            "telephone_number": "580-622-2208",
            "fax_number": "580-622-2212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 W BROADWAY AVE",
            "city": "SULPHUR",
            "state": "OK",
            "postal_code": "730864611",
            "telephone_number": "580-622-2208",
            "fax_number": "580-622-2212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOONER PHARMACY OF OKLAHOMA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-05",
        "last_updated": "2013-11-05",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "DEWAYNE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "580-622-2208"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "OK",
            "license": "55-6470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OKLAHOMA STATE BOARD OF PHARMACY",
            "identifier": "55-6470",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacy in Sulphur, OK
• Providers in Sulphur, OK by specialty
• Pharmacy in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.