Provider Demographics
NPI:1386921849
Name:BREWER, MARY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-6113
Mailing Address - Country:US
Mailing Address - Phone:918-252-9297
Mailing Address - Fax:918-252-9307
Practice Address - Street 1:3600 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-6113
Practice Address - Country:US
Practice Address - Phone:918-252-9297
Practice Address - Fax:918-252-9307
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist