Provider Demographics
NPI:1609076264
Name:BAGENT, DIANA SUE (DPH)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:SUE
Last Name:BAGENT
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 1:900 N OWEN WALTERS BLVD
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:OK
Mailing Address - Zip Code:74365-5003
Mailing Address - Country:US
Mailing Address - Phone:918-434-8507
Mailing Address - Fax:918-434-8597
Practice Address - Street 1:900 N OWEN WALTERS BLVD
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:OK
Practice Address - Zip Code:74365-5003
Practice Address - Country:US
Practice Address - Phone:918-434-8507
Practice Address - Fax:918-434-8597
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist