Provider Demographics
NPI:1649496720
Name:ADCOCK, SANDRA LYNN (BS PHARMACY MSM)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LYNN
Last Name:ADCOCK
Suffix:
Gender:F
Credentials:BS PHARMACY MSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11717 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6989
Mailing Address - Country:US
Mailing Address - Phone:405-850-0595
Mailing Address - Fax:
Practice Address - Street 1:11717 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6989
Practice Address - Country:US
Practice Address - Phone:405-123-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist