Provider Demographics
NPI:1881160083
Name:WEEKS, MICHAEL TRAVIS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TRAVIS
Last Name:WEEKS
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:PO BOX 1243
Mailing Address - Street 2:
Mailing Address - City:KREBS
Mailing Address - State:OK
Mailing Address - Zip Code:74554-1243
Mailing Address - Country:US
Mailing Address - Phone:501-288-2659
Mailing Address - Fax:
Practice Address - Street 1:125 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:KREBS
Practice Address - State:OK
Practice Address - Zip Code:74554
Practice Address - Country:US
Practice Address - Phone:501-288-2659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18167183500000X
ARPD14601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist