Healthcare Provider Details

I. General information

NPI: 1497318240
Provider Name (Legal Business Name): MICAH R COLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 NW HWY 270 LONGHORN BUILDING STE A
SEILING OK
73663
US

IV. Provider business mailing address

PO BOX 1046
SEILING OK
73663-1046
US

V. Phone/Fax

Practice location:
  • Phone: 580-922-4403
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14283
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: