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General NPI Number Information
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NPI Number | 1780221838
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Entity Type | Individual
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Provider Name | CALLIE JEAN HATAWAY PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/09/2019
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Last Update Date | 12/09/2019
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Provider Practice Location Address
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Address Line | 913 MANVEL AVE
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City | CHANDLER
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State | OK
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Zip | 74834-3851
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Country | US
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Telephone | 405-258-1218
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Fax |
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Provider Business Mailing Address
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Address Line | 1709 NW 173RD ST
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City | EDMOND
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State | OK
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Zip | 73012-7005
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Country | US
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Telephone | 405-593-0009
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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 | 15473
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License Number State | OK
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