Provider Demographics
NPI:1003166687
Name:HEARON, CHARLES (PHRAMD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:HEARON
Suffix:
Gender:M
Credentials:PHRAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 BUTTERFIELD TRL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-1036
Mailing Address - Country:US
Mailing Address - Phone:405-664-5699
Mailing Address - Fax:
Practice Address - Street 1:302 UNIVERSITY PL
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-7110
Practice Address - Country:US
Practice Address - Phone:580-920-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist