Provider Demographics
NPI:1043922081
Name:CHANCE, QUAJUNE
Entity Type:Individual
Prefix:
First Name:QUAJUNE
Middle Name:
Last Name:CHANCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:QUE
Other - Middle Name:
Other - Last Name:CHANCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4317 SW 22ND ST APT 1902
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-1942
Mailing Address - Country:US
Mailing Address - Phone:215-789-0745
Mailing Address - Fax:
Practice Address - Street 1:2316 N ROCKWELL AVE
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-5852
Practice Address - Country:US
Practice Address - Phone:405-440-0342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKI-10733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist