Provider Demographics
NPI:1609920065
Name:BEARDEN, JOHN GLEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GLEN
Last Name:BEARDEN
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 1:2301 S EIGHT TRIBES TRL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-1009
Mailing Address - Country:US
Mailing Address - Phone:918-542-7158
Mailing Address - Fax:
Practice Address - Street 1:2301 S EIGHT TRIBES TRL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-1009
Practice Address - Country:US
Practice Address - Phone:918-542-7158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK132591835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy