Provider Demographics
NPI:1063558518
Name:HOWARD, BILLIE CLYDE (DPH)
Entity type:Individual
Prefix:MR
First Name:BILLIE
Middle Name:CLYDE
Last Name:HOWARD
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 1:1206 WINDSOR PL
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-2342
Mailing Address - Country:US
Mailing Address - Phone:405-275-5375
Mailing Address - Fax:
Practice Address - Street 1:2803 SARATOGA ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1739
Practice Address - Country:US
Practice Address - Phone:405-273-9417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist