Provider Demographics
NPI:1902175011
Name:CHANDLER, KLEM PRICE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KLEM
Middle Name:PRICE
Last Name:CHANDLER
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 1:2512 ROBIN RD
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-3031
Mailing Address - Country:US
Mailing Address - Phone:580-765-7987
Mailing Address - Fax:
Practice Address - Street 1:2300 N 14TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1729
Practice Address - Country:US
Practice Address - Phone:580-767-1584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist