Provider Demographics
NPI:1992086409
Name:DOUGHTY, PETE SMITH JR (DPH)
Entity type:Individual
Prefix:MR
First Name:PETE
Middle Name:SMITH
Last Name:DOUGHTY
Suffix:JR
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 SCOTTS BLF
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-4873
Mailing Address - Country:US
Mailing Address - Phone:405-919-6993
Mailing Address - Fax:
Practice Address - Street 1:615 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-7062
Practice Address - Country:US
Practice Address - Phone:405-573-5019
Practice Address - Fax:405-573-9827
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist