Provider Demographics
NPI:1750512273
Name:WILSON, DEBRA JEAN (DPH)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JEAN
Last Name:WILSON
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 1:132 W TAFT ST
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-5433
Mailing Address - Country:US
Mailing Address - Phone:918-224-3600
Mailing Address - Fax:918-224-3902
Practice Address - Street 1:132 W TAFT ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-5433
Practice Address - Country:US
Practice Address - Phone:918-224-3600
Practice Address - Fax:918-224-3902
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist