Healthcare Provider Details

I. General information

NPI: 1508391053
Provider Name (Legal Business Name): COLTON TURNBULL DPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 W MAIN ST
COLLINSVILLE OK
74021-3114
US

IV. Provider business mailing address

1205 W MAIN ST
COLLINSVILLE OK
74021-3114
US

V. Phone/Fax

Practice location:
  • Phone: 918-371-2547
  • Fax: 918-371-0268
Mailing address:
  • Phone: 918-371-2547
  • Fax: 918-371-0268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15514
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: