Healthcare Provider Details

I. General information

NPI: 1710805965
Provider Name (Legal Business Name): AMANDA MCDANIEL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7512 BROADWAY EXT STE 308
OKLAHOMA CITY OK
73116-9055
US

IV. Provider business mailing address

7512 BROADWAY EXT STE 308
OKLAHOMA CITY OK
73116-9055
US

V. Phone/Fax

Practice location:
  • Phone: 888-404-6050
  • Fax: 405-653-9445
Mailing address:
  • Phone: 888-404-6050
  • Fax: 405-653-9445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14920
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: