Provider Demographics
NPI:1235277476
Name:HUTTON, DENNIS WILLIAM
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:WILLIAM
Last Name:HUTTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 BEL AIR AVE
Mailing Address - Street 2:
Mailing Address - City:BLACKWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74631-5103
Mailing Address - Country:US
Mailing Address - Phone:580-363-0755
Mailing Address - Fax:580-363-5582
Practice Address - Street 1:419 BEL AIR AVE
Practice Address - Street 2:
Practice Address - City:BLACKWELL
Practice Address - State:OK
Practice Address - Zip Code:74631-5103
Practice Address - Country:US
Practice Address - Phone:580-363-0755
Practice Address - Fax:580-363-5582
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8378183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist