Individual
PENNY D SOUTHERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPH
Contact information
Practice address
2307 S GORDON COOPER DR, SHAWNEE, OK 74801-9007
(405) 273-5236
(405) 273-2392
Mailing address
2307 S GORDON COOPER DR, SHAWNEE, OK 74801-9007
(405) 273-5236
(405) 273-2392
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10652
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10652
STATE BOARD OF PHARMACY #
OK
Enumeration date
06/23/2006
Last updated
07/08/2007
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