Healthcare Provider Details

I. General information

NPI: 1174079065
Provider Name (Legal Business Name): CAITLIN TODHUNTER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLIN WITHROW

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S BLISS AVE
TAHLEQUAH OK
74464-2512
US

IV. Provider business mailing address

100 S BLISS AVE
TAHLEQUAH OK
74464-2512
US

V. Phone/Fax

Practice location:
  • Phone: 919-458-3100
  • Fax:
Mailing address:
  • Phone: 919-458-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number17051
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: