Provider Demographics
NPI:1891804035
Name:PRITCHARD, JIM C
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:C
Last Name:PRITCHARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 RAWSON RD
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-4008
Mailing Address - Country:US
Mailing Address - Phone:918-245-7764
Mailing Address - Fax:918-245-5906
Practice Address - Street 1:540 PLAZA CT
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-7915
Practice Address - Country:US
Practice Address - Phone:918-245-9696
Practice Address - Fax:918-245-5906
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist