Healthcare Provider Details

I. General information

NPI: 1306318688
Provider Name (Legal Business Name): MEGAN COBURN PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2018
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 MANVEL AVE
CHANDLER OK
74834-3851
US

IV. Provider business mailing address

913 MANVEL AVE
CHANDLER OK
74834-3851
US

V. Phone/Fax

Practice location:
  • Phone: 405-258-1218
  • Fax: 405-258-2046
Mailing address:
  • Phone: 405-258-1218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14057
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: