Provider Demographics
NPI:1699007922
Name:FRICK, KURT J (PD)
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:J
Last Name:FRICK
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15563 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-5483
Mailing Address - Country:US
Mailing Address - Phone:918-396-7578
Mailing Address - Fax:
Practice Address - Street 1:7912 E 31ST CT
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-1315
Practice Address - Country:US
Practice Address - Phone:918-728-7654
Practice Address - Fax:918-245-6568
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist