Provider Demographics
NPI:1073158978
Name:PINKERTON, ALEX (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:PINKERTON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-3806
Mailing Address - Country:US
Mailing Address - Phone:918-696-2500
Mailing Address - Fax:918-696-5556
Practice Address - Street 1:202 S 2ND ST
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-3806
Practice Address - Country:US
Practice Address - Phone:918-696-2500
Practice Address - Fax:918-696-5556
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist