Provider Demographics
NPI:1780221838
Name:HATAWAY, CALLIE JEAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:JEAN
Last Name:HATAWAY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 NW 173RD ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-7005
Mailing Address - Country:US
Mailing Address - Phone:405-593-0009
Mailing Address - Fax:
Practice Address - Street 1:913 MANVEL AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-3851
Practice Address - Country:US
Practice Address - Phone:405-258-1218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist