Provider Demographics
NPI:1588073621
Name:CANNON, J'MARIA CECILE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:J'MARIA
Middle Name:CECILE
Last Name:CANNON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-3922
Mailing Address - Country:US
Mailing Address - Phone:580-226-6978
Mailing Address - Fax:580-226-7543
Practice Address - Street 1:1111 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-3922
Practice Address - Country:US
Practice Address - Phone:580-226-6978
Practice Address - Fax:580-226-7543
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-02
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist