Provider Demographics
NPI:1043438427
Name:ROSS, CHARLOTTE SUE (DPH)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:SUE
Last Name:ROSS
Suffix:
Gender:F
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:RR 1 BOX 48
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:OK
Mailing Address - Zip Code:73741-9717
Mailing Address - Country:US
Mailing Address - Phone:580-852-3354
Mailing Address - Fax:
Practice Address - Street 1:2600 E WILLOW RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-8715
Practice Address - Country:US
Practice Address - Phone:580-548-2627
Practice Address - Fax:580-548-2652
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist