Healthcare Provider Details

I. General information

NPI: 1770753121
Provider Name (Legal Business Name): AMANDA MARIE SKAGGS PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 09/20/2025
Certification Date: 09/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 S PAUL CARR DR
CHECOTAH OK
74426-2063
US

IV. Provider business mailing address

RR 6 BOX 840
STILWELL OK
74960-8703
US

V. Phone/Fax

Practice location:
  • Phone: 918-473-5404
  • Fax: 918-473-2719
Mailing address:
  • Phone: 918-696-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14206
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: