Provider Demographics
NPI:1346928256
Name:CHANCE, BROCK LYNN (PHARM D)
Entity Type:Individual
Prefix:
First Name:BROCK
Middle Name:LYNN
Last Name:CHANCE
Suffix:
Gender:M
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 1:540 PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-7994
Mailing Address - Country:US
Mailing Address - Phone:918-245-9693
Mailing Address - Fax:918-245-5906
Practice Address - Street 1:540 PLAZA CT
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-7994
Practice Address - Country:US
Practice Address - Phone:918-245-9693
Practice Address - Fax:918-245-5906
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20055183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist