Provider Demographics
NPI:1295001881
Name:BALFOUR-GRICE, WILLIAM DEAN (DPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DEAN
Last Name:BALFOUR-GRICE
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13212 BRIAR HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-6934
Mailing Address - Country:US
Mailing Address - Phone:405-735-7272
Mailing Address - Fax:405-735-7272
Practice Address - Street 1:301 S. JT STITES ST.
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955
Practice Address - Country:US
Practice Address - Phone:918-774-1422
Practice Address - Fax:918-774-1422
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103061835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist