MEDICARE: DR. CARA DENAE ZELLNER PHARMD

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	18755	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18755	OTHER	OK	OKLAHOMA STATE BOARD OF PHARMACY

General Provider Information

NPI Number	:	1225650203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARA DENAE ZELLNER PHARMD

Provider Business Mailing Address
First Line	:	814 COUNTY STREET 2986
Second Line	:
City	:	BLANCHARD
State	:	OK
Zip	:	73010-4433
Country	:	US
Telephone Number	:	405-808-8916
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 TINKER DIAGONAL
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-4622
Country	:	US
Telephone Number	:	405-670-1030
Fax Number	:

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

Provider Enumeration Date	:	05/12/2020
Last Update Date	:	05/12/2020

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