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NPI Code Detail

MEDICARE: JEFFERY COLE CATES DPH

MEDICARE: JEFFERY COLE CATES DPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist9500OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19500OTHEROKOKLAHOMA STATE BOARD OF PHARMACY

General Provider Information

NPI Number : 1548558828
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFERY COLE CATES DPH
Provider Business Mailing Address
First Line : 2508 NW 25TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73107-2206
Country : US
Telephone Number : 405-943-9412
Fax Number :
Provider Business Practice Location Address
First Line : 781 GRAND CASINO BLVD
Second Line :
City : SHAWNEE
State : OK
Zip : 74804-1005
Country : US
Telephone Number : 405-964-5770
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2011
Last Update Date : 07/20/2011

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