Provider Demographics
NPI:1407924285
Name:BLEWETT, VICTORIA E (DPH)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:E
Last Name:BLEWETT
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:HC 67 BOX 330
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-9508
Mailing Address - Country:US
Mailing Address - Phone:580-298-2575
Mailing Address - Fax:
Practice Address - Street 1:208 N HIGH ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-2216
Practice Address - Country:US
Practice Address - Phone:580-298-3377
Practice Address - Fax:580-298-6260
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist