MEDICARE: RHONDA KAYE COTHRAN DPH

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	11373	OK

General Provider Information

NPI Number	:	1699888578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHONDA KAYE COTHRAN DPH

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	:	5701 N PORTLAND AVE
Second Line	:	123
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-1678
Country	:	US
Telephone Number	:	405-949-6410
Fax Number	:	405-949-6412

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/08/2007

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