Provider Demographics
NPI:1275250359
Name:HARRELL, DOUG ALLAN
Entity Type:Individual
Prefix:
First Name:DOUG
Middle Name:ALLAN
Last Name:HARRELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12902 E 96TH ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4778
Mailing Address - Country:US
Mailing Address - Phone:918-272-2376
Mailing Address - Fax:918-272-3335
Practice Address - Street 1:12902 E 96TH ST N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4778
Practice Address - Country:US
Practice Address - Phone:918-272-2376
Practice Address - Fax:918-272-3335
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist