MEDICARE: MR. TERRY J COTHRAN RPH

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	11237	OK

General Provider Information

NPI Number	:	1407960131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TERRY J COTHRAN RPH

Provider Business Mailing Address
First Line	:	1513 PEACHTREE CT
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73003-2920
Country	:	US
Telephone Number	:	405-359-9042
Fax Number	:

Provider Business Practice Location Address
First Line	:	755 RESEARCH PKWY
Second Line	:	SUITE 200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-3612
Country	:	US
Telephone Number	:	405-234-3112
Fax Number	:

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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