Provider Demographics
NPI:1003999673
Name:HUTTON II, HAROLD R (DPH)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:R
Last Name:HUTTON II
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 1:205 E TONKAWA AVE
Mailing Address - Street 2:BOX 506
Mailing Address - City:TONKAWA
Mailing Address - State:OK
Mailing Address - Zip Code:74653-3511
Mailing Address - Country:US
Mailing Address - Phone:580-628-3312
Mailing Address - Fax:580-628-3322
Practice Address - Street 1:205 E TONKAWA AVE
Practice Address - Street 2:BOX 506
Practice Address - City:TONKAWA
Practice Address - State:OK
Practice Address - Zip Code:74653-3511
Practice Address - Country:US
Practice Address - Phone:580-628-3312
Practice Address - Fax:580-628-3322
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7373183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist