Provider Demographics
NPI:1588932701
Name:DUHON, CHARLES LEO (RPH)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:LEO
Last Name:DUHON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 S LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5058
Mailing Address - Country:US
Mailing Address - Phone:918-747-8841
Mailing Address - Fax:
Practice Address - Street 1:8709 S 70TH E AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5058
Practice Address - Country:US
Practice Address - Phone:918-747-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist