Provider Demographics
NPI:1710326822
Name:ALONSO, PETER A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:ALONSO
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 1:9412 E 97TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5165
Mailing Address - Country:US
Mailing Address - Phone:918-809-5851
Mailing Address - Fax:
Practice Address - Street 1:10106 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6731
Practice Address - Country:US
Practice Address - Phone:918-528-3700
Practice Address - Fax:918-527-3701
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist