Individual
MICKEY PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
721 W BRITTON RD, OKLAHOMA CITY, OK 73114-2909
(405) 632-6688
Mailing address
3605 NW 175TH ST, EDMOND, OK 73012-6901
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13871
OK
Other
Enumeration date
12/23/2024
Last updated
12/23/2024
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