Provider Demographics
NPI:1174962039
Name:BEESON, LINDA K (CPHT)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:K
Last Name:BEESON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10424 NW 45TH ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-2307
Mailing Address - Country:US
Mailing Address - Phone:817-980-4830
Mailing Address - Fax:405-354-6137
Practice Address - Street 1:1099 GARTH BROOKS BLVD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4104
Practice Address - Country:US
Practice Address - Phone:405-350-1251
Practice Address - Fax:405-354-6137
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKT6463183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician