Provider Demographics
NPI:1154766681
Name:REED, REBECCA (DPH)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:REED
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 1:814 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-4527
Mailing Address - Country:US
Mailing Address - Phone:580-223-7636
Mailing Address - Fax:
Practice Address - Street 1:814 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-4527
Practice Address - Country:US
Practice Address - Phone:580-223-7636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11015183500000X
TX29088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist