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NPI Code Detail

MEDICARE: AL THARYN NACTHIGALL DPH

MEDICARE: AL THARYN NACTHIGALL 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
1183500000XPharmacist8388OK

General Provider Information

NPI Number : 1619035722
Entity Type Code : Individual
Provider Name (Legal Business Name) : AL THARYN NACTHIGALL DPH
Provider Business Mailing Address
First Line : PO BOX 82
Second Line :
City : COLLINSVILLE
State : OK
Zip : 74021-0082
Country : US
Telephone Number : 918-371-2547
Fax Number : 918-371-0268
Provider Business Practice Location Address
First Line : 1205 W MAIN ST
Second Line :
City : COLLINSVILLE
State : OK
Zip : 74021-3114
Country : US
Telephone Number : 918-371-2547
Fax Number : 918-371-0268
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2006
Last Update Date : 07/08/2007

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Directions to “ AL THARYN NACTHIGALL DPH” Practice Location

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