Healthcare Provider Details

I. General information

NPI: 1548747850
Provider Name (Legal Business Name): CHANDRA VUE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E KENOSHA ST
BROKEN ARROW OK
74012-2071
US

IV. Provider business mailing address

950 E KENOSHA ST
BROKEN ARROW OK
74012-2071
US

V. Phone/Fax

Practice location:
  • Phone: 918-251-3996
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17954
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: