Organization
RT FAMILY DISCOUNT PHARMACY LTC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TROY SIMONS (PRESIDENT)
(405) 742-8099
Entity
Organization
Contact information
Practice address
310 FAIRVIEW AVE, PONCA CITY, OK 74601-2001
(580) 762-6335
Mailing address
310 FAIRVIEW AVE, PONCA CITY, OK 74601-2001
(580) 762-6335
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6-5546
OKLAHOMA STATE BOARD OF PHARMACY
OK
Enumeration date
04/26/2022
Last updated
04/26/2022
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