Healthcare Provider Details

I. General information

NPI: 1548272578
Provider Name (Legal Business Name): MONTE LYNN STRUTTON D.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CORNER OF OSAGE & WASHBOURNE
JAY OK
74346-4205
US

IV. Provider business mailing address

1015 WASHBOURNE ST.
JAY OK
74346-4205
US

V. Phone/Fax

Practice location:
  • Phone: 918-253-4271
  • Fax: 918-253-8349
Mailing address:
  • Phone: 918-253-4271
  • Fax: 918-253-8349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9995
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: