Provider Demographics
NPI:1225540842
Name:DARTEZ, DAMIAN (RPH)
Entity Type:Individual
Prefix:
First Name:DAMIAN
Middle Name:
Last Name:DARTEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 N MARTIN LUTHER KING AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-2405
Mailing Address - Country:US
Mailing Address - Phone:405-424-0557
Mailing Address - Fax:405-424-0105
Practice Address - Street 1:2323 N MARTIN LUTHER KING AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-2405
Practice Address - Country:US
Practice Address - Phone:405-424-0557
Practice Address - Fax:405-424-0105
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-05
Last Update Date:2017-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK162833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy