Basic Information
| Provider Information | |||||||||
| NPI: | 1386184968 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STAJDUHAR | ||||||||
| FirstName: | NIKOLAS | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | PHARMD, BCPS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 CHUKKAHINA | ||||||||
| Address2: | |||||||||
| City: | DURANT | ||||||||
| State: | OK | ||||||||
| PostalCode: | 747017117 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1801 CHUKKAHINA | ||||||||
| Address2: | |||||||||
| City: | DURANT | ||||||||
| State: | OK | ||||||||
| PostalCode: | 747017117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5809202100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2017 | ||||||||
| LastUpdateDate: | 03/02/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 16553 | OK | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.