Provider Demographics
NPI:1376820746
Name:SKALICKY, FRANK ZANE (RPH)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:ZANE
Last Name:SKALICKY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-6936
Mailing Address - Country:US
Mailing Address - Phone:918-876-4906
Mailing Address - Fax:
Practice Address - Street 1:3816 E FRANK PHILLIPS BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-8316
Practice Address - Country:US
Practice Address - Phone:918-333-0588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-13
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist