Provider Demographics
NPI:1134210248
Name:BLACKBURN, MEGHAN BROOKE (PHARM D)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:BROOKE
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-6011
Mailing Address - Country:US
Mailing Address - Phone:918-207-8939
Mailing Address - Fax:
Practice Address - Street 1:RR 6 BOX 840
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-8703
Practice Address - Country:US
Practice Address - Phone:918-696-8800
Practice Address - Fax:918-696-8881
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist