Healthcare Provider Details

I. General information

NPI: 1003999673
Provider Name (Legal Business Name): HAROLD R HUTTON II D.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E TONKAWA AVE BOX 506
TONKAWA OK
74653-3511
US

IV. Provider business mailing address

205 E TONKAWA AVE BOX 506
TONKAWA OK
74653-3511
US

V. Phone/Fax

Practice location:
  • Phone: 580-628-3312
  • Fax: 580-628-3322
Mailing address:
  • Phone: 580-628-3312
  • Fax: 580-628-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7373
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: