Provider Demographics
NPI:1932636453
Name:SOONER DISCOUNT PHARMACY LLC
Entity Type:Organization
Organization Name:SOONER DISCOUNT PHARMACY LLC
Other - Org Name:SOONER DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANT
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:405-329-6001
Mailing Address - Street 1:1811 W LINDSEY ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-4101
Mailing Address - Country:US
Mailing Address - Phone:405-329-6001
Mailing Address - Fax:405-329-6002
Practice Address - Street 1:1811 W LINDSEY ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-4101
Practice Address - Country:US
Practice Address - Phone:405-329-6001
Practice Address - Fax:405-329-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-15
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7-76343336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200713760AMedicaid