Provider Demographics
NPI:1184173155
Name:WON, PAUL DAEHAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAEHAN
Last Name:WON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:DAEHAN
Other - Last Name:WON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:19820 E 45TH ST S
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-8211
Mailing Address - Country:US
Mailing Address - Phone:918-355-3114
Mailing Address - Fax:
Practice Address - Street 1:1000 W SHAWNEE ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-3509
Practice Address - Country:US
Practice Address - Phone:918-687-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist