Provider Demographics
NPI:1831191600
Name:COY, RAYMOND NEALE JR (DPH)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:NEALE
Last Name:COY
Suffix:JR
Gender:M
Credentials:DPH
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Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-0098
Mailing Address - Country:US
Mailing Address - Phone:405-454-6261
Mailing Address - Fax:405-454-6262
Practice Address - Street 1:19655 NE 23RD ST
Practice Address - Street 2:
Practice Address - City:HARRAH
Practice Address - State:OK
Practice Address - Zip Code:73045-9305
Practice Address - Country:US
Practice Address - Phone:405-454-6261
Practice Address - Fax:405-454-6262
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK8661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK8661OtherPHARMACY LISCENSE