Provider Demographics
NPI:1427031632
Name:FRYMIRE, JANE ANNE (DPH)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ANNE
Last Name:FRYMIRE
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 1 BOX 105A
Mailing Address - Street 2:
Mailing Address - City:THOMAS
Mailing Address - State:OK
Mailing Address - Zip Code:73669-9755
Mailing Address - Country:US
Mailing Address - Phone:580-661-3800
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 34A
Practice Address - Street 2:
Practice Address - City:WATONGA
Practice Address - State:OK
Practice Address - Zip Code:73772-9706
Practice Address - Country:US
Practice Address - Phone:580-623-4991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist