Provider Demographics
NPI:1235737214
Name:PEASE, MALORIE DENISE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MALORIE
Middle Name:DENISE
Last Name:PEASE
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 1:715 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PAWHUSKA
Mailing Address - State:OK
Mailing Address - Zip Code:74056-3201
Mailing Address - Country:US
Mailing Address - Phone:918-287-9300
Mailing Address - Fax:
Practice Address - Street 1:715 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-3201
Practice Address - Country:US
Practice Address - Phone:918-287-9300
Practice Address - Fax:918-287-1555
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist