Individual
ANDREA SOUTHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPH
Contact information
Practice address
205 SW SHERIDAN RD, LAWTON, OK 73505-1518
(580) 248-0300
Mailing address
205 SW SHERIDAN RD, LAWTON, OK 73505-1518
(580) 248-0300
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
16208
OK
Other
Enumeration date
11/18/2020
Last updated
11/18/2020
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