Provider Demographics
NPI:1225142201
Name:PREFERRED PHCY PROVIDERS OF SE OK
Entity Type:Organization
Organization Name:PREFERRED PHCY PROVIDERS OF SE OK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUFF
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-889-9191
Mailing Address - Street 1:116 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-2032
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:116 E COURT ST
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-2032
Practice Address - Country:US
Practice Address - Phone:580-889-9191
Practice Address - Fax:580-889-9194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5748263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3723889OtherOTHER ID NUMBER-COMMERCIAL NUMBER