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Organization
BRINE AND BEAM LTC
Active
Organization
BRINE AND BEAM LTC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TROY SIMONS (PRESIDENT)
(405) 742-8099
Entity
Organization
Contact information
Practice address
1419 COMMERCIAL AVE, MOUNDS, OK 74047-0580
(918) 827-6301
Mailing address
PO BOX 580, MOUNDS, OK 74047-0580
(918) 827-6301
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11--8325
OKLAHOMA STATE BOARD OF PHARMACY
OK
Enumeration date
04/27/2022
Last updated
04/27/2022
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