Provider Demographics
NPI:1386230019
Name:REESE, STUART (PHARMD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:REESE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S CHICKASAW ST
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-4601
Mailing Address - Country:US
Mailing Address - Phone:405-238-7505
Mailing Address - Fax:405-238-7506
Practice Address - Street 1:505 S CHICKASAW ST
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-4601
Practice Address - Country:US
Practice Address - Phone:405-238-7505
Practice Address - Fax:405-238-7506
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist