Healthcare Provider Details

I. General information

NPI: 1184533549
Provider Name (Legal Business Name): SHAYLA PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16603 W SOUTH AVE
TONKAWA OK
74653-4707
US

IV. Provider business mailing address

16603 W SOUTH AVE
TONKAWA OK
74653-4707
US

V. Phone/Fax

Practice location:
  • Phone: 580-557-0085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21523
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: