Provider Demographics
NPI:1083991020
Name:KAISER, CHARLENE (DPH)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:
Last Name:KAISER
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 1:4725 E 181ST ST S
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-5753
Mailing Address - Country:US
Mailing Address - Phone:918-366-2107
Mailing Address - Fax:
Practice Address - Street 1:4725 E 181ST ST S
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-5753
Practice Address - Country:US
Practice Address - Phone:918-366-2107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist