Provider Demographics
NPI:1861485559
Name:SOONER PHARMACY
Entity Type:Organization
Organization Name:SOONER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D, PHD
Authorized Official - Phone:580-622-2208
Mailing Address - Street 1:815 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-4611
Mailing Address - Country:US
Mailing Address - Phone:580-622-2208
Mailing Address - Fax:580-622-2200
Practice Address - Street 1:815 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-4611
Practice Address - Country:US
Practice Address - Phone:580-622-2208
Practice Address - Fax:580-622-2200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK55-3551333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3703128OtherNCPDP
0426080001Medicare ID - Type Unspecified