Healthcare Provider Details

I. General information

NPI: 1992629760
Provider Name (Legal Business Name): MELISSA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15832 W BRITTON RD
YUKON OK
73099-8544
US

IV. Provider business mailing address

15832 W BRITTON RD
YUKON OK
73099-8544
US

V. Phone/Fax

Practice location:
  • Phone: 405-313-5492
  • Fax:
Mailing address:
  • Phone: 405-313-5492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11887
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: