Provider Demographics
NPI:1891514550
Name:WAFFORD, CHANCE (PHARMD)
Entity type:Individual
Prefix:
First Name:CHANCE
Middle Name:
Last Name:WAFFORD
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 1:24557 N 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FORT GIBSON
Mailing Address - State:OK
Mailing Address - Zip Code:74434-6224
Mailing Address - Country:US
Mailing Address - Phone:918-781-2217
Mailing Address - Fax:
Practice Address - Street 1:1904 CARL ALBERT BLVD STE A
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-3493
Practice Address - Country:US
Practice Address - Phone:580-421-4569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist