Provider Demographics
NPI:1194381160
Name:VILLINES, MARK S (DPH, RPH)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:S
Last Name:VILLINES
Suffix:
Gender:M
Credentials:DPH, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 RADIO RD
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2991
Mailing Address - Country:US
Mailing Address - Phone:580-924-7425
Mailing Address - Fax:
Practice Address - Street 1:1026 RADIO RD
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2991
Practice Address - Country:US
Practice Address - Phone:580-924-7425
Practice Address - Fax:580-924-0525
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist