Provider Demographics
NPI:1154428696
Name:PITTMAN, DAVID R (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 579
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086
Mailing Address - Country:US
Mailing Address - Phone:580-622-2208
Mailing Address - Fax:580-622-2200
Practice Address - Street 1:815 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086
Practice Address - Country:US
Practice Address - Phone:580-622-2208
Practice Address - Fax:580-622-2200
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist