Provider Demographics
NPI:1124468558
Name:KNOWLES, DANA TIM (DPH)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:TIM
Last Name:KNOWLES
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 1:591 S MILL ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-6015
Mailing Address - Country:US
Mailing Address - Phone:918-825-5306
Mailing Address - Fax:918-825-3151
Practice Address - Street 1:591 S MILL ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-6015
Practice Address - Country:US
Practice Address - Phone:918-825-5306
Practice Address - Fax:918-825-3151
Is Sole Proprietor?:No
Enumeration Date:2013-06-29
Last Update Date:2013-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist