Provider Demographics
NPI:1700922317
Name:JIMS TOWER PHARMACY INC
Entity Type:Organization
Organization Name:JIMS TOWER PHARMACY INC
Other - Org Name:JIMS TOWER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAKEBILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-631-9625
Mailing Address - Street 1:1024 SW 44TH ST STE 700
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3618
Mailing Address - Country:US
Mailing Address - Phone:405-631-9625
Mailing Address - Fax:405-632-5268
Practice Address - Street 1:1024 SW 44TH ST STE 700
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3618
Practice Address - Country:US
Practice Address - Phone:405-631-9625
Practice Address - Fax:405-632-5268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OK125833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2074120OtherPK
OK100237530AMedicaid