Provider Demographics
NPI:1578667531
Name:WILLIAM H PITTMAN
Entity Type:Organization
Organization Name:WILLIAM H PITTMAN
Other - Org Name:DOOLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-446-4524
Mailing Address - Street 1:4120 S 25TH WEST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-6506
Mailing Address - Country:US
Mailing Address - Phone:918-446-4524
Mailing Address - Fax:918-446-9438
Practice Address - Street 1:4120 S 25TH WEST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107-6506
Practice Address - Country:US
Practice Address - Phone:918-446-4524
Practice Address - Fax:918-446-9438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OK22353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100232620AMedicaid
3708154OtherNCPDP PROVIDER IDENTIFICATION NUMBER
OK100232620AMedicaid