Provider Demographics
NPI:1689729410
Name:STINCHCOMB, KATIE LEIGH (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:LEIGH
Last Name:STINCHCOMB
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9321 VIERTON RD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-8366
Mailing Address - Country:US
Mailing Address - Phone:918-420-5772
Mailing Address - Fax:918-423-4736
Practice Address - Street 1:601 E WYANDOTTE AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5425
Practice Address - Country:US
Practice Address - Phone:918-423-2980
Practice Address - Fax:918-423-4736
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist