Provider Demographics
NPI:1306494851
Name:CULLEY, PATRICK ALLEN (PHARMD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:ALLEN
Last Name:CULLEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-5204
Mailing Address - Country:US
Mailing Address - Phone:405-262-3212
Mailing Address - Fax:405-422-3323
Practice Address - Street 1:210 W ELM ST
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-5204
Practice Address - Country:US
Practice Address - Phone:405-262-3212
Practice Address - Fax:405-422-3323
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist