Healthcare Provider Details

I. General information

NPI: 1124254313
Provider Name (Legal Business Name): BEVERLY CANNON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1438 HARDCASTLE BLVD
PURCELL OK
73080-8233
US

IV. Provider business mailing address

1438 HARDCASTLE BLVD
PURCELL OK
73080-8233
US

V. Phone/Fax

Practice location:
  • Phone: 405-527-4911
  • Fax:
Mailing address:
  • Phone: 405-527-4911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number14232
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number19629
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: