Provider Demographics
NPI:1295851772
Name:DEATLEY, VICKI LEE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:LEE
Last Name:DEATLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2489 JETT HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:OH
Mailing Address - Zip Code:45157-9532
Mailing Address - Country:US
Mailing Address - Phone:513-553-0732
Mailing Address - Fax:
Practice Address - Street 1:131 N POINT DR
Practice Address - Street 2:
Practice Address - City:MOUNT ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154-8366
Practice Address - Country:US
Practice Address - Phone:937-444-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-23056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist