Provider Demographics
NPI:1437618477
Name:CANADAY, MICHAEL TERRY (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TERRY
Last Name:CANADAY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 E 54TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-7511
Mailing Address - Country:US
Mailing Address - Phone:918-344-6974
Mailing Address - Fax:
Practice Address - Street 1:1823 S CARSON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-5007
Practice Address - Country:US
Practice Address - Phone:918-630-1774
Practice Address - Fax:918-583-7747
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009027306183500000X
OK14624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist