Healthcare Provider Details

I. General information

NPI: 1659485118
Provider Name (Legal Business Name): AMOS MALONE DPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: AMOS MALONE CCN

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 N CHURCH AVE
HARRAH OK
73045-0247
US

IV. Provider business mailing address

2430 CHOCTAW DR
CHOCTAW OK
73020-6565
US

V. Phone/Fax

Practice location:
  • Phone: 405-454-2477
  • Fax: 405-454-3507
Mailing address:
  • Phone: 405-454-2476
  • Fax: 405-454-3507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberOK 8116
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number3739
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: