Provider Demographics
NPI:1871138727
Name:HOOPER, BRIAN ALLEN (DPH)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ALLEN
Last Name:HOOPER
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 NE 36TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-2508
Mailing Address - Country:US
Mailing Address - Phone:405-290-3423
Mailing Address - Fax:405-290-3523
Practice Address - Street 1:9225 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-4418
Practice Address - Country:US
Practice Address - Phone:405-751-7119
Practice Address - Fax:405-751-7824
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist