Provider Demographics
NPI:1396881686
Name:O'GRADY, SIDNEY MICHAEL (MS, RPH, DPH)
Entity type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:MICHAEL
Last Name:O'GRADY
Suffix:
Gender:M
Credentials:MS, RPH, DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17183 COUNTY ROAD 3547
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-7938
Mailing Address - Country:US
Mailing Address - Phone:580-421-1508
Mailing Address - Fax:580-421-6035
Practice Address - Street 1:430 N MONTE VISTA ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4610
Practice Address - Country:US
Practice Address - Phone:580-421-1508
Practice Address - Fax:580-421-6035
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31334183500000X
OK13762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist