Provider Demographics
NPI:1932744034
Name:PECINA, MARTIN (DPH)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:PECINA
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6802 E 88TH ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-7593
Mailing Address - Country:US
Mailing Address - Phone:918-694-3448
Mailing Address - Fax:
Practice Address - Street 1:6802 E 88TH ST N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-7593
Practice Address - Country:US
Practice Address - Phone:918-694-3448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31529561835P1200X
OK12883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy