Provider Demographics
NPI:1942645304
Name:WALTERS, COTY MICHAEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:COTY
Middle Name:MICHAEL
Last Name:WALTERS
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 1:1801 BELLE ISLE BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-4221
Mailing Address - Country:US
Mailing Address - Phone:405-841-6516
Mailing Address - Fax:405-841-6518
Practice Address - Street 1:1801 BELLE ISLE BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4221
Practice Address - Country:US
Practice Address - Phone:405-841-6516
Practice Address - Fax:405-841-6518
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist