Healthcare Provider Details

I. General information

NPI: 1831790344
Provider Name (Legal Business Name): EDWARD HUTTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E 1ST ST
CHANDLER OK
74834-9585
US

IV. Provider business mailing address

3100 E 1ST ST
CHANDLER OK
74834-9585
US

V. Phone/Fax

Practice location:
  • Phone: 405-258-2012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9628
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: