Organization
PRAIRIE GARDENS PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TROY SIMONS PHARMD (PRESIDENT)
(405) 742-8099
Entity
Organization
Contact information
Practice address
12301 N WESTERN AVE STE 106, OKLAHOMA CITY, OK 73114-8017
(405) 768-1818
(405) 768-1919
Mailing address
824 S WALNUT ST, STILLWATER, OK 74074-4225
(405) 768-1818
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-9220
OKLAHOMA STATE BOARD OF PHARMACY
OK
Enumeration date
05/20/2022
Last updated
11/23/2022
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