Provider Demographics
NPI:1497006274
Name:HANCIN, DYLAN MATTHEW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:MATTHEW
Last Name:HANCIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 WESTMINSTER PLACE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120
Mailing Address - Country:US
Mailing Address - Phone:918-269-5713
Mailing Address - Fax:
Practice Address - Street 1:3840 S 103RD EAST AVE
Practice Address - Street 2:#234
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-2438
Practice Address - Country:US
Practice Address - Phone:918-660-0576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist