Provider Demographics
NPI:1063026326
Name:OWENS, KAYLA MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:OWENS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29978 E 143RD ST S
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-7697
Mailing Address - Country:US
Mailing Address - Phone:918-284-7693
Mailing Address - Fax:
Practice Address - Street 1:405 E 2ND ST
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-7948
Practice Address - Country:US
Practice Address - Phone:918-246-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK18923OtherPHARMACIST LICENSE