Provider Demographics
NPI:1619037330
Name:CHONLAHAN, METHA (DPH)
Entity Type:Individual
Prefix:DR
First Name:METHA
Middle Name:
Last Name:CHONLAHAN
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 RIPPLE AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-1913
Mailing Address - Country:US
Mailing Address - Phone:405-701-0814
Mailing Address - Fax:
Practice Address - Street 1:4009 RIPPLE AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-1913
Practice Address - Country:US
Practice Address - Phone:405-701-0814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12511183500000X, 1835P1200X, 1835G0303X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Not Answered1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Not Answered1835P1300XPharmacy Service ProvidersPharmacistPsychiatric