Provider Demographics
NPI:1699888578
Name:COTHRAN, RHONDA KAYE (DPH)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:KAYE
Last Name:COTHRAN
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 PEACHTREE CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-2920
Mailing Address - Country:US
Mailing Address - Phone:405-359-9042
Mailing Address - Fax:
Practice Address - Street 1:5701 N PORTLAND AVE
Practice Address - Street 2:123
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-1678
Practice Address - Country:US
Practice Address - Phone:405-949-6410
Practice Address - Fax:405-949-6412
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11373183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist