Provider Demographics
NPI:1578844064
Name:DOYLE, RONALD STEPHEN (DPH)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:STEPHEN
Last Name:DOYLE
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SHAWNEE MALL DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1322
Mailing Address - Country:US
Mailing Address - Phone:405-878-1437
Mailing Address - Fax:405-878-1196
Practice Address - Street 1:600 SHAWNEE MALL DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1322
Practice Address - Country:US
Practice Address - Phone:405-878-1437
Practice Address - Fax:405-878-1196
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist