Provider Demographics
NPI:1154601623
Name:SAMUEL, RAICHEL JOHN (DPH)
Entity type:Individual
Prefix:DR
First Name:RAICHEL
Middle Name:JOHN
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11009 S OAK AVE
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-2615
Mailing Address - Country:US
Mailing Address - Phone:918-296-9871
Mailing Address - Fax:
Practice Address - Street 1:11332 E 31ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-1905
Practice Address - Country:US
Practice Address - Phone:918-622-9684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist