Provider Demographics
NPI:1083741383
Name:SIMONS, TROY
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:SIMONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 N ROCK CT
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-8817
Mailing Address - Country:US
Mailing Address - Phone:405-372-4882
Mailing Address - Fax:
Practice Address - Street 1:328 N 6TH ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077-6607
Practice Address - Country:US
Practice Address - Phone:580-336-2136
Practice Address - Fax:580-336-9445
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK12299OtherOKLAHOMA PHARMACY #