Provider Demographics
NPI:1265035232
Name:DOWERS, JANESSA SHAWN
Entity Type:Individual
Prefix:
First Name:JANESSA
Middle Name:SHAWN
Last Name:DOWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 GARTH BROOKS BLVD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4107
Mailing Address - Country:US
Mailing Address - Phone:405-305-0500
Mailing Address - Fax:405-350-0605
Practice Address - Street 1:1200 GARTH BROOKS BLVD # 221
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4107
Practice Address - Country:US
Practice Address - Phone:405-350-0500
Practice Address - Fax:405-350-0605
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK11506OtherDPH LICENSE NUMBER