Provider Demographics
NPI:1104395920
Name:GILBERT, PATRA KOSITCHAIWAT (MBA, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PATRA
Middle Name:KOSITCHAIWAT
Last Name:GILBERT
Suffix:
Gender:F
Credentials:MBA, PHARMD
Other - Prefix:DR
Other - First Name:PATRA
Other - Middle Name:
Other - Last Name:KOSITCHAIWAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2323 N MARTIN LUTHER KING AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-2496
Mailing Address - Country:US
Mailing Address - Phone:405-424-0557
Mailing Address - Fax:405-424-0105
Practice Address - Street 1:2323 N MARTIN LUTHER KING AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-2496
Practice Address - Country:US
Practice Address - Phone:405-424-0557
Practice Address - Fax:405-424-0105
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist