Provider Demographics
NPI:1518923887
Name:SIMPSON PHARMACY, PLLC
Entity Type:Organization
Organization Name:SIMPSON PHARMACY, PLLC
Other - Org Name:SIMPSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/PIC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:580-584-2850
Mailing Address - Street 1:802 N PARK DR
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:OK
Mailing Address - Zip Code:74728-2146
Mailing Address - Country:US
Mailing Address - Phone:580-584-2850
Mailing Address - Fax:580-584-2820
Practice Address - Street 1:802 N PARK DR
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:OK
Practice Address - Zip Code:74728-2146
Practice Address - Country:US
Practice Address - Phone:580-584-2850
Practice Address - Fax:580-584-2820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X
OK25-51063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2077059OtherPK
OK200082880AMedicaid
572766001Medicare PIN
OK5727660001Medicare ID - Type UnspecifiedMEDICARE
OK200082880AMedicaid