MEDICARE: MR. LYNN MOGG D.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	8636	OK

General Provider Information

NPI Number	:	1871664078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LYNN MOGG D.PH.

Provider Business Mailing Address
First Line	:	7201 E RENO AVE
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-4484
Country	:	US
Telephone Number	:	405-737-3451
Fax Number	:	405-733-7061

Provider Business Practice Location Address
First Line	:	7201 E RENO AVE
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-4484
Country	:	US
Telephone Number	:	405-737-3451
Fax Number	:	405-733-7061

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

Provider Enumeration Date	:	11/11/2006
Last Update Date	:	07/09/2007

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