Provider Demographics
NPI:1407869548
Name:RICH, JANE (DPH)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:RICH
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:RR 2 BOX 115A
Mailing Address - Street 2:
Mailing Address - City:PRAGUE
Mailing Address - State:OK
Mailing Address - Zip Code:74864-9527
Mailing Address - Country:US
Mailing Address - Phone:405-567-3798
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 247
Practice Address - Street 2:
Practice Address - City:STROUD
Practice Address - State:OK
Practice Address - Zip Code:74079-9652
Practice Address - Country:US
Practice Address - Phone:918-968-9531
Practice Address - Fax:918-968-0113
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist