Provider Demographics
NPI:1811441579
Name:SIMPSON, ROBERT (PHARM D)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W CHOCTAW ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-3808
Mailing Address - Country:US
Mailing Address - Phone:918-947-8180
Mailing Address - Fax:918-947-8199
Practice Address - Street 1:200 W CHOCTAW ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3808
Practice Address - Country:US
Practice Address - Phone:918-947-8180
Practice Address - Fax:918-947-8199
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK17048OtherOKLAHOMA STATE BOARD OF PHARMACY