MR. THEODORE MAUCK (NPI# 1285114504) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285114504 |
| Entity Type | Individual |
| Full Name | MR. THEODORE MAUCK |
| Credential | DPH |
| Practice Address |
1923 S Utica Ave Tulsa OK 74104-6520 |
| Mailing Address |
4013 W Vicksburg St Broken Arrow OK 74011-1359 |
| Practice Telephone | 9187443131 |
| Practice Fax Number | 9187443063 |
| Mailing Telephone | 9186332456 |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2018-08-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 12846 | OK | Pharmacy Service Providers |
| Street Address |
1923 S UTICA AVE |
| City | TULSA |
| State | OK |
| Zip Code | 74104-6520 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174527667 | Mark Douglas Mills | Pharmacist | 1923 S Utica Ave, Tulsa, OK 74104-6520 | 2005-06-13 |
| 1043848880 | Saba Imani | Student in an Organized Health Care Education/Training Program | 1923 S Utica Ave, Tulsa, OK 74104-6520 | 2020-03-28 |
| 1073146312 | Tammy Irene Joplin | Clinical Nurse Specialist | 1923 S Utica Ave, Tulsa, OK 74104-6520 | 2020-02-14 |
| 1962047563 | Houston Reed Slemp | Nurse Practitioner | 1923 S Utica Ave, Tulsa, OK 74104-6520 | 2019-11-07 |
| 1558903369 | Nicole Coburn | Physician Assistant | 1923 S Utica Ave, Tulsa, OK 74104-6520 | 2019-10-14 |
| 1124669643 | Jordan Beasley | Physician Assistant | 1923 S Utica Ave, Tulsa, OK 74104-6520 | 2019-10-06 |
| 1558926683 | Jacob Blasdel | Student in an Organized Health Care Education/Training Program | 1923 S Utica Ave, Tulsa, OK 74104-6520 | 2019-05-03 |
| 1487217634 | Candice R Rogers | Student in an Organized Health Care Education/Training Program | 1923 S Utica Ave, Tulsa, OK 74104-6520 | 2019-04-15 |
| 1881158178 | Ellen Chadick | Anesthesiologist Assistant | 1923 S Utica Ave, Tulsa, OK 74104-6520 | 2019-01-30 |
| 1528522810 | Hannah Chadick | Anesthesiologist Assistant | 1923 S Utica Ave, Tulsa, OK 74104-6520 | 2019-01-30 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982253811 | Ultimate Health and Pain Management | Pain Medicine | 1844 East 15th Street, Tulsa, OK 74104 | 2019-09-04 |
| 1225691223 | David Murray | Student in an Organized Health Care Education/Training Program | 2100 S Wheeling Ave, Tulsa, OK 74104 | 2019-04-16 |
| 1083115828 | Susan Fortner | Counselor | 1328 S. Delaware Pl, Tulsa, OK 74104 | 2018-02-27 |
| 1033636915 | Mark Brizendine | Dietitian, Registered | Hillcrest Medical Center 1120 S. Utica Ave, Tulsa, OK 74104 | 2017-08-23 |
| 1295259067 | Demi Reyd Cook | Nurse Practitioner | 1717 A South Utica, Tulsa, OK 74104 | 2017-08-02 |
| 1851827059 | Oklahoma Cvs Pharmacy | Durable Medical Equipment & Medical Supplies | 1701 E 15th Street, Tulsa, OK 74104 | 2017-05-08 |
| 1801334982 | Jamie Lynne Miller | Internal Medicine | 2000 S. Wheeling Avenue Ste 510, Tulsa, OK 74104 | 2017-02-08 |
| 1578913430 | Donna Durant-macon | Registered Nurse | 315 South Utica, Tulsa, OK 74104 | 2016-06-21 |
| 1669833851 | Mbc Dental | Dentist | 401 S. Utica Ave, #a, Tulsa, OK 74104 | 2016-03-15 |
| 1518332170 | Neuro Dynamics LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 22 S Lewis, Tulsa, OK 74104 | 2015-12-08 |
| Find all providers in zip 74104 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932709664 | Nouha Hilal | Pharmacist | 8241 S 100th East Pl, Tulsa, OK 74133-4545 | 2020-10-30 |
| 1497392476 | Polly Gretchen Robinson | Pharmacist | W 2nd St., Suite 100, Communitycare, Tulsa, OK 74103 | 2019-12-09 |
| 1760027866 | Chelsea Nicole Crisp | Pharmacist | 1406 S Marion Ave, Tulsa, OK 74112-5923 | 2019-11-12 |
| 1982260683 | Shawn Crismon | Pharmacist | 6802 S Olympia Ave Ste 125, Tulsa, OK 74132-1830 | 2019-05-17 |
| 1437618477 | Michael Terry Canaday | Pharmacist | 1823 S Carson Ave, Tulsa, OK 74119-5007 | 2019-03-19 |
| 1205308749 | Ricky E Burgess | Pharmacist | 12515 E 55th St Ste 101, Tulsa, OK 74146-6234 | 2018-12-21 |
| 1568951366 | James D Fotenopulos | Pharmacist | 1924 S Utica Ave # 416, Tulsa, OK 74104-6510 | 2018-05-07 |
| 1235641010 | Darin Coggins | Pharmacist | 115 W 3rd St Unit 820, Tulsa, OK 74103-3410 | 2017-11-01 |
| 1275044752 | Owen Cabrera | Pharmacist | 7041 S Yale Ave, Tulsa, OK 74136-5701 | 2017-10-24 |
| 1881104131 | Austen Leigh Patterson | Pharmacist | 6116 S Lewis Ave, Tulsa, OK 74136-1001 | 2017-10-01 |
| Find all providers in TULSA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.