Provider Demographics
NPI:1346397999
Name:ROTHER, LEAH D'ANN (RPH)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:D'ANN
Last Name:ROTHER
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 1:125 G ST SW
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-4753
Mailing Address - Country:US
Mailing Address - Phone:580-226-9545
Mailing Address - Fax:
Practice Address - Street 1:16662 US HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:LONE GROVE
Practice Address - State:OK
Practice Address - Zip Code:73443
Practice Address - Country:US
Practice Address - Phone:580-657-3555
Practice Address - Fax:580-657-3555
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist