Individual
MR. TIM PATRICK O'CONNOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPH
Contact information
Practice address
1113 E HARTFORD AVE, PONCA CITY, OK 74601-2016
(580) 765-3055
(580) 765-3410
Mailing address
5325 LAKE RD, PONCA CITY, OK 74604-5110
(580) 762-8034
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11604
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3707215
NCPDP
OK
Enumeration date
08/20/2006
Last updated
07/09/2007
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