1326476938 NPI number — DEANA GAYLE SWEATT PHARM.D.

Table of content: DEANA GAYLE SWEATT PHARM.D. (NPI 1326476938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326476938 NPI number — DEANA GAYLE SWEATT PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWEATT
Provider First Name:
DEANA
Provider Middle Name:
GAYLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326476938
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 TURTLE DRIVE
Provider Second Line Business Mailing Address:
BEARSKIN HEALTH CLINIC PHARMACY
Provider Business Mailing Address City Name:
WYANDOTTE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-678-3244
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 TURTLE DR
Provider Second Line Business Practice Location Address:
BEARSKIN HEALTH CLINIC PHARMACY
Provider Business Practice Location Address City Name:
WYANDOTTE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74370-2114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-678-3244
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  11437 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: RPH 38863 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11437 . This is a "OKLAHOMA STATE BOARD OF PHARMACY" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: RPH 38863 . This is a "CALIFORNIA STATE BOARD OF PHARMACY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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