Provider Demographics
NPI:1083215826
Name:COADY, MICHELLE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:COADY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8471 SW DEYO MISSION RD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-8815
Mailing Address - Country:US
Mailing Address - Phone:580-351-8590
Mailing Address - Fax:
Practice Address - Street 1:3745 SW LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8322
Practice Address - Country:US
Practice Address - Phone:580-713-7703
Practice Address - Fax:580-713-7704
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist