MEDICARE: SHELLY JANET STOCKTON R.PH., PH.D.

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	11194	OK

General Provider Information

NPI Number	:	1942398722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY JANET STOCKTON R.PH., PH.D.

Provider Business Mailing Address
First Line	:	RR 1 BOX 3445
Second Line	:
City	:	CLINTON
State	:	OK
Zip	:	73601-9332
Country	:	US
Telephone Number	:	405-694-3190
Fax Number	:	580-774-7020

Provider Business Practice Location Address
First Line	:	900 N PORTER AVE STE 101
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73071-6426
Country	:	US
Telephone Number	:	405-364-5222
Fax Number	:	405-364-7076

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/09/2007

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