Provider Demographics
NPI:1740422856
Name:COATS, DEREK LANCE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:LANCE
Last Name:COATS
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 1:200 S ADAIR ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-5202
Mailing Address - Country:US
Mailing Address - Phone:918-825-3059
Mailing Address - Fax:918-825-7714
Practice Address - Street 1:200 S ADAIR ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-5202
Practice Address - Country:US
Practice Address - Phone:918-825-3059
Practice Address - Fax:918-825-7714
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist