Provider Demographics
NPI:1699802876
Name:EASLON, ALICIA R (PHARM D)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:R
Last Name:EASLON
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 1:11802 VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-6446
Mailing Address - Country:US
Mailing Address - Phone:918-371-5456
Mailing Address - Fax:
Practice Address - Street 1:11815 E 86TH ST N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-2536
Practice Address - Country:US
Practice Address - Phone:918-272-3030
Practice Address - Fax:918-272-5353
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist