Provider Demographics
NPI:1588248876
Name:LANDRETH, ROCHELLE ELAINE (PHARMD)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:ELAINE
Last Name:LANDRETH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-9817
Mailing Address - Country:US
Mailing Address - Phone:405-485-9311
Mailing Address - Fax:405-485-9311
Practice Address - Street 1:301 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-9817
Practice Address - Country:US
Practice Address - Phone:405-485-9311
Practice Address - Fax:405-485-9312
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty