Healthcare Provider Details

I. General information

NPI: 1366839029
Provider Name (Legal Business Name): KELLYE PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395200 W 2900 RD
OCHELATA OK
74501
US

IV. Provider business mailing address

395200 W 2900 RD
OCHELATA OK
74501
US

V. Phone/Fax

Practice location:
  • Phone: 918-535-6000
  • Fax:
Mailing address:
  • Phone: 918-535-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15730
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: