Provider Demographics
NPI:1720256696
Name:MCAULIFF, RICHARD MARK (DPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MARK
Last Name:MCAULIFF
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:DR
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:MCAULIFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9614 S 92ND EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6127
Mailing Address - Country:US
Mailing Address - Phone:918-249-4696
Mailing Address - Fax:918-249-4696
Practice Address - Street 1:9614 S 92ND EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6127
Practice Address - Country:US
Practice Address - Phone:918-249-4696
Practice Address - Fax:918-249-4696
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist