Provider Demographics
NPI:1184217663
Name:COVALT, DEBBIE DAWN
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:DAWN
Last Name:COVALT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-3002
Mailing Address - Country:US
Mailing Address - Phone:580-256-6600
Mailing Address - Fax:580-254-2835
Practice Address - Street 1:1310 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3002
Practice Address - Country:US
Practice Address - Phone:580-256-6600
Practice Address - Fax:580-254-2835
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist