Provider Demographics
NPI:1528103363
Name:BLOSS, MARION DEAN (DPH)
Entity type:Individual
Prefix:DR
First Name:MARION
Middle Name:DEAN
Last Name:BLOSS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
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Mailing Address - Street 1:24143 HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:PARK HILL
Mailing Address - State:OK
Mailing Address - Zip Code:74451-4011
Mailing Address - Country:US
Mailing Address - Phone:918-456-8432
Mailing Address - Fax:918-431-1155
Practice Address - Street 1:26245 HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:PARK HILL
Practice Address - State:OK
Practice Address - Zip Code:74451-2802
Practice Address - Country:US
Practice Address - Phone:918-431-0505
Practice Address - Fax:918-431-1155
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK7352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7352OtherSTATE PHARMACY LICENSE