Individual provider Active NPI

Andrea Southerland, DPH

  • Pharmacist
  • Lawton, OK
National Provider Identifier
1972106359
Registry record updated Nov 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
16208 Issued in OK
Practice address
205 SW Sheridan Rd
Lawton, OK 73505-1518
Phone
(580) 248-0300
NPI assigned
Nov 18, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 16208 OK Primary

Addresses

Primary practice location

205 SW Sheridan Rd
Lawton, OK 73505-1518

Mailing address

205 SW Sheridan Rd
Lawton, OK 73505-1518
Phone (580) 248-0300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
16208OKMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Buy for Less Discount Pharmacy PastSince Nov 22, 2020 Accepting new patients
Buy for Less Discount Pharmacy PastSince Nov 22, 2020 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605657600000",
    "number": "1972106359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 SW SHERIDAN RD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735051518",
            "telephone_number": "580-248-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 SW SHERIDAN RD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735051518",
            "telephone_number": "580-248-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHERLAND",
        "first_name": "ANDREA",
        "credential": "DPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-18",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OK",
            "license": "16208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawton, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.