Healthcare Provider Details

I. General information

NPI: 1699888578
Provider Name (Legal Business Name): RHONDA KAYE COTHRAN DPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 N PORTLAND AVE 123
OKLAHOMA CITY OK
73112-1678
US

IV. Provider business mailing address

1513 PEACHTREE CT
EDMOND OK
73003-2920
US

V. Phone/Fax

Practice location:
  • Phone: 405-949-6410
  • Fax: 405-949-6412
Mailing address:
  • Phone: 405-359-9042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11373
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: