Provider Demographics
NPI:1215021894
Name:ROWE, DIANE MICHELE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MICHELE
Last Name:ROWE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 HOUSE CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:SPRINGER
Mailing Address - State:OK
Mailing Address - Zip Code:73458
Mailing Address - Country:US
Mailing Address - Phone:405-642-2337
Mailing Address - Fax:
Practice Address - Street 1:815 W. BROADWAY
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086
Practice Address - Country:US
Practice Address - Phone:580-622-2208
Practice Address - Fax:580-622-2200
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist