Healthcare Provider Details

I. General information

NPI: 1497944102
Provider Name (Legal Business Name): CASSANDRA BROCKELMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 3060
CLINTON OK
73601-9303
US

IV. Provider business mailing address

2105 MORGANDEE LN
WEATHERFORD OK
73096-2949
US

V. Phone/Fax

Practice location:
  • Phone: 580-331-3351
  • Fax: 580-331-3555
Mailing address:
  • Phone: 580-331-3351
  • Fax: 580-331-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number14002
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: