Provider Demographics
NPI:1083210306
Name:FEIGHTNER, ZACHARY (DPH)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:
Last Name:FEIGHTNER
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 1:2005 N 14TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1919
Mailing Address - Country:US
Mailing Address - Phone:580-762-7444
Mailing Address - Fax:580-765-5110
Practice Address - Street 1:2005 N 14TH ST STE 110
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1919
Practice Address - Country:US
Practice Address - Phone:580-762-7444
Practice Address - Fax:580-765-5110
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist