Provider Demographics
NPI:1326476938
Name:SWEATT, DEANA GAYLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:GAYLE
Last Name:SWEATT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TURTLE DRIVE
Mailing Address - Street 2:BEARSKIN HEALTH CLINIC PHARMACY
Mailing Address - City:WYANDOTTE
Mailing Address - State:OK
Mailing Address - Zip Code:74370
Mailing Address - Country:US
Mailing Address - Phone:918-678-3244
Mailing Address - Fax:
Practice Address - Street 1:1 TURTLE DR
Practice Address - Street 2:BEARSKIN HEALTH CLINIC PHARMACY
Practice Address - City:WYANDOTTE
Practice Address - State:OK
Practice Address - Zip Code:74370-2114
Practice Address - Country:US
Practice Address - Phone:918-678-3244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11437183500000X
CARPH 38863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK11437OtherOKLAHOMA STATE BOARD OF PHARMACY
CARPH 38863OtherCALIFORNIA STATE BOARD OF PHARMACY