MEDICARE: DR. GARRETT REAN HUXALL 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	1835P1200X	Pharmacotherapy Pharmacist	OK 9725	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CGP 757	OTHER	VA	GERATRICS BOARD CERT
2	OK 9725	OTHER	OK	OKLAHOMA PHARMACY NUMBER

General Provider Information

NPI Number	:	1568465268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARRETT REAN HUXALL PHARMD

Provider Business Mailing Address
First Line	:	22122 E 63RD ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74014-2007
Country	:	US
Telephone Number	:	918-355-6148
Fax Number	:	918-355-7158

Provider Business Practice Location Address
First Line	:	22122 E 63RD ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74014-2007
Country	:	US
Telephone Number	:	918-355-6148
Fax Number	:	918-355-7158

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/08/2007

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