Provider Demographics
NPI:1477156636
Name:ALFRED, CATHY SUE (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:SUE
Last Name:ALFRED
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16226 N COUNTY ROAD 3265
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075
Mailing Address - Country:US
Mailing Address - Phone:405-238-0541
Mailing Address - Fax:
Practice Address - Street 1:2008 W GRANT AVE
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-9230
Practice Address - Country:US
Practice Address - Phone:405-238-7525
Practice Address - Fax:405-238-7135
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist