MEDICARE: MR. NEAL G KOHNKE R.PH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	9529	OK

General Provider Information

NPI Number	:	1184766347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NEAL G KOHNKE R.PH

Provider Business Mailing Address
First Line	:	825 S WALNUT ST
Second Line	:
City	:	STILLWATER
State	:	OK
Zip	:	74074-4226
Country	:	US
Telephone Number	:	405-372-7900
Fax Number	:	405-377-5139

Provider Business Practice Location Address
First Line	:	825 S WALNUT ST
Second Line	:
City	:	STILLWATER
State	:	OK
Zip	:	74074-4226
Country	:	US
Telephone Number	:	405-372-7900
Fax Number	:	405-377-5139

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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