Provider Demographics
NPI:1497392476
Name:ROBINSON, POLLY GRETCHEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:POLLY
Middle Name:GRETCHEN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 S ROCKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-5810
Mailing Address - Country:US
Mailing Address - Phone:918-629-2126
Mailing Address - Fax:
Practice Address - Street 1:W 2ND ST., SUITE 100
Practice Address - Street 2:COMMUNITYCARE
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74103
Practice Address - Country:US
Practice Address - Phone:918-594-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3336M0003X
OK12549183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK12549OtherPHARMACY LICENSE NUMBER