Provider Demographics
NPI:1407960131
Name:COTHRAN, TERRY J (RPH)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:J
Last Name:COTHRAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 PEACHTREE CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-2920
Mailing Address - Country:US
Mailing Address - Phone:405-359-9042
Mailing Address - Fax:
Practice Address - Street 1:755 RESEARCH PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-3612
Practice Address - Country:US
Practice Address - Phone:405-234-3112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist