# PRAIRIE GARDENS PHARMACY LTC INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346988565
- **Authorized official:** TROY SIMONS DPH (PRESIDENT)
- **Authorized official phone:** (405) 742-8099

## Contact information

- **Practice address:** 12301 N WESTERN AVE STE 106, OKLAHOMA CITY, OK 73114-8017
- **Practice address phone:** (405) 768-1818
- **Practice address fax:** (405) 768-1919
- **Mailing address:** 824 S WALNUT ST, STILLWATER, OK 74074-4225
- **Mailing address phone:** (918) 510-0648

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 05/26/2022
- **Last updated:** 11/18/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1-9220 | OKLAHOMA STATE BOARD OF PHARMACY | OK |