Provider Demographics
NPI:1033628417
Name:PANAK-STUART, REBEKAH LAUREN (PHARMD, RPH, MS)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LAUREN
Last Name:PANAK-STUART
Suffix:
Gender:F
Credentials:PHARMD, RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 W SYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-1532
Mailing Address - Country:US
Mailing Address - Phone:419-470-0700
Mailing Address - Fax:419-470-0700
Practice Address - Street 1:1400 E 2ND ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5321
Practice Address - Country:US
Practice Address - Phone:918-955-1694
Practice Address - Fax:405-216-9660
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171341835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK17134OtherOKLAHOMA STATE BOARD OF PHARMACY