Provider Demographics
NPI:1760937247
Name:PARENTEAU, EVELYN DELORIS (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:DELORIS
Last Name:PARENTEAU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 SE 16TH PLACE
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73065-5315
Mailing Address - Country:US
Mailing Address - Phone:580-917-7670
Mailing Address - Fax:
Practice Address - Street 1:HAC-INC-HOMELAND #169
Practice Address - Street 2:205 N COMMERCE
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401
Practice Address - Country:US
Practice Address - Phone:580-223-0143
Practice Address - Fax:580-223-7620
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17287183500000X
AL19479183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty