Provider Demographics
NPI:1922608413
Name:DWIGGINS, AMY DAWN (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:DAWN
Last Name:DWIGGINS
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 1:19108 E REDBERRY RD
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-7448
Mailing Address - Country:US
Mailing Address - Phone:918-978-9746
Mailing Address - Fax:
Practice Address - Street 1:12101 E 96TH ST N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-5320
Practice Address - Country:US
Practice Address - Phone:918-272-1134
Practice Address - Fax:918-272-6645
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist