Provider Demographics
NPI:1235728486
Name:HILBURN, CLETA ANN
Entity Type:Individual
Prefix:
First Name:CLETA
Middle Name:ANN
Last Name:HILBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CLETA
Other - Middle Name:ANN
Other - Last Name:HILBURN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPH
Mailing Address - Street 1:PO BOX 832
Mailing Address - Street 2:
Mailing Address - City:NOBLE
Mailing Address - State:OK
Mailing Address - Zip Code:73068-0832
Mailing Address - Country:US
Mailing Address - Phone:405-326-7185
Mailing Address - Fax:405-382-5704
Practice Address - Street 1:1701 N MILT PHILLIPS AVE
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-2333
Practice Address - Country:US
Practice Address - Phone:405-382-1467
Practice Address - Fax:405-382-5704
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10297183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist