Provider Demographics
NPI:1154934719
Name:CHAPPLE, SUZETTE MICHELE (DPH)
Entity type:Individual
Prefix:MRS
First Name:SUZETTE
Middle Name:MICHELE
Last Name:CHAPPLE
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 1:6011 S 15TH PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-5101
Mailing Address - Country:US
Mailing Address - Phone:918-685-0042
Mailing Address - Fax:
Practice Address - Street 1:6011 S 15TH PL
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-5101
Practice Address - Country:US
Practice Address - Phone:918-685-0042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist