Healthcare Provider Details

I. General information

NPI: 1407960131
Provider Name (Legal Business Name): TERRY J COTHRAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 RESEARCH PKWY SUITE 200
OKLAHOMA CITY OK
73104-3612
US

IV. Provider business mailing address

1513 PEACHTREE CT
EDMOND OK
73003-2920
US

V. Phone/Fax

Practice location:
  • Phone: 405-234-3112
  • Fax:
Mailing address:
  • Phone: 405-359-9042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11237
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: