Provider Demographics
NPI:1164821823
Name:JOSEPH, SHIRLEY GAIL (DPH)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:GAIL
Last Name:JOSEPH
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 1:2 S COVEY ST
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:OK
Mailing Address - Zip Code:73662-3125
Mailing Address - Country:US
Mailing Address - Phone:580-243-8552
Mailing Address - Fax:
Practice Address - Street 1:100 N 30TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3117
Practice Address - Country:US
Practice Address - Phone:580-323-8335
Practice Address - Fax:580-323-8369
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9187183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist