Healthcare Provider Details

I. General information

NPI: 1497765366
Provider Name (Legal Business Name): MRS. ROBIN GAYLE UNDERWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1442 N HARRISON ST
SHAWNEE OK
74801-5208
US

IV. Provider business mailing address

19408 HARRISON RD
SHAWNEE OK
74801-8629
US

V. Phone/Fax

Practice location:
  • Phone: 405-273-9906
  • Fax: 405-273-4329
Mailing address:
  • Phone: 405-273-7766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberT-2688
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: