Provider Demographics
NPI:1558617092
Name:FLEGAL, SAMUEL COREY (PHARMD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:COREY
Last Name:FLEGAL
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 1:4112 S PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-7613
Mailing Address - Country:US
Mailing Address - Phone:918-743-4491
Mailing Address - Fax:918-743-5432
Practice Address - Street 1:4112 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-7613
Practice Address - Country:US
Practice Address - Phone:918-743-4491
Practice Address - Fax:918-743-5432
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist