Provider Demographics
NPI:1841223773
Name:PICKETT, BRADLEY SCOTT (DPH)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:SCOTT
Last Name:PICKETT
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 1:509 CASA ALEGRE CIR
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-1126
Mailing Address - Country:US
Mailing Address - Phone:580-482-8302
Mailing Address - Fax:
Practice Address - Street 1:205 S PARK LN STE 110
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-5733
Practice Address - Country:US
Practice Address - Phone:580-482-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist