Provider Demographics
NPI:1376764035
Name:FORCUM, JOE WILLIAM (DPH)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:WILLIAM
Last Name:FORCUM
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 1:600 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:OK
Mailing Address - Zip Code:74016-2030
Mailing Address - Country:US
Mailing Address - Phone:918-576-8186
Mailing Address - Fax:918-789-3705
Practice Address - Street 1:600 WALNUT ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:OK
Practice Address - Zip Code:74016-2030
Practice Address - Country:US
Practice Address - Phone:918-789-2241
Practice Address - Fax:918-789-3705
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005040952183500000X
OK9927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist