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General NPI Number Information
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NPI Number | 1306664727
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Entity Type | Individual
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Provider Name | MAKENNA CHEYENNE ROSE
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Gender | Female
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 2345 N CLASSEN BLVD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73106-5804
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Country | US
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Telephone | 405-521-0924
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Fax | 405-521-0944
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Provider Business Mailing Address
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Address Line | 8405 NW 112TH TER
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City | OKLAHOMA CITY
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State | OK
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Zip | 73162-2116
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Country | US
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Telephone | 580-651-3113
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Fax |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | R-20673
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License Number State | OK
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