Provider Demographics
NPI:1689261315
Name:GARRETT, GINA DANIELLE (DPH)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:DANIELLE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:DANIELLE TURNER
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1007 N COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2847
Mailing Address - Country:US
Mailing Address - Phone:580-421-8775
Mailing Address - Fax:580-421-8789
Practice Address - Street 1:1007 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2847
Practice Address - Country:US
Practice Address - Phone:580-421-8775
Practice Address - Fax:580-421-8789
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist