Healthcare Provider Details

I. General information

NPI: 1558610337
Provider Name (Legal Business Name): BRAD JIMMIE HAYES-MILLIGAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 WILL ROGERS PKWY STE 200
OKLAHOMA CITY OK
73108-1826
US

IV. Provider business mailing address

4350 WILL ROGERS PKWY STE 200
OKLAHOMA CITY OK
73108-1826
US

V. Phone/Fax

Practice location:
  • Phone: 405-948-4602
  • Fax: 405-512-6900
Mailing address:
  • Phone: 405-948-4602
  • Fax: 405-512-6900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number12737
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number41985
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPH57215
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: