Provider Demographics
NPI:1568465268
Name:HUXALL, GARRETT REAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:REAN
Last Name:HUXALL
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 1:22122 E 63RD ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-2007
Mailing Address - Country:US
Mailing Address - Phone:918-355-6148
Mailing Address - Fax:918-355-7158
Practice Address - Street 1:22122 E 63RD ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-2007
Practice Address - Country:US
Practice Address - Phone:918-355-6148
Practice Address - Fax:918-355-7158
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK 97251835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACGP 757OtherGERATRICS BOARD CERT
OKOK 9725OtherOKLAHOMA PHARMACY NUMBER