Provider Demographics
NPI:1366044117
Name:SCHMIDT, CHRISTEN LYNN (DPH)
Entity Type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:LYNN
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216810 E COUNTY ROAD 43
Mailing Address - Street 2:
Mailing Address - City:MOORELAND
Mailing Address - State:OK
Mailing Address - Zip Code:73852-5213
Mailing Address - Country:US
Mailing Address - Phone:580-216-0069
Mailing Address - Fax:
Practice Address - Street 1:193461 E COUNTY ROAD 304
Practice Address - Street 2:
Practice Address - City:FT SUPPLY
Practice Address - State:OK
Practice Address - Zip Code:73841
Practice Address - Country:US
Practice Address - Phone:580-733-2311
Practice Address - Fax:580-766-2316
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist