| Doctor Name: | KELLY TATE |
| NPI Number: | 1558481812 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | T10378 |
| Business Practice Address: | 1438 Hardcastle Blvd Purcell, OK - 730808233 |
| Business Phone Number: | 4055274700 |
| Business Fax Number: | 5805590610 |
| Mailing Address: | 1001 N Country Club Rd, ADA |
| State: | OK |
| Postal Code: | 748202847 |
| Phone Number: | 5804214570 |
| Fax Number: | 5804216283 |
| NPI Enumeration Date: | 03/30/2007 |
| NPI Last Update Date: | 07/24/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 183700000X |
| License Number: | T10378 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacy Technician |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person who works under the direct supervision of a licensed pharmacist and performs many pharmacy-related functions that do not require the professional judgment of a pharmacist. |