Provider Demographics
NPI:1437246857
Name:CAREL, KIMERA JANICE (DPH)
Entity Type:Individual
Prefix:MS
First Name:KIMERA
Middle Name:JANICE
Last Name:CAREL
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 1:7638 NW FOLKSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505
Mailing Address - Country:US
Mailing Address - Phone:580-585-5401
Mailing Address - Fax:580-510-7033
Practice Address - Street 1:3201 WEST GORE BOULEVARD
Practice Address - Street 2:GREAT PLAINS PHARMACY
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505
Practice Address - Country:US
Practice Address - Phone:580-585-5401
Practice Address - Fax:580-510-7033
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100749570RMedicaid