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General NPI Number Information
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NPI Number | 1083951248
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Entity Type | Individual
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Provider Name | JERRY DAVID FRASER D.PH.
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Gender | Male
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Dates
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Enumeration Date | 01/08/2013
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Last Update Date | 01/08/2013
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Provider Practice Location Address
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Address Line | 1101 HONOR HEIGHTS DR PHARMACY DEPARTMENT
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City | MUSKOGEE
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State | OK
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Zip | 74401-1302
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Country | US
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Telephone | 918-577-3185
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Fax | 918-577-4463
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Provider Business Mailing Address
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Address Line | 1101 HONOR HEIGHTS DR PHARMACY DEPARTMENT
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City | MUSKOGEE
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State | OK
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Zip | 74401-1302
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Country | US
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Telephone | 918-577-3185
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Fax | 918-577-4463
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 9765
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License Number State | OK
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