Provider Demographics
NPI:1831470368
Name:BOUSE, REBECCA L (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:L
Last Name:BOUSE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3265 STAGHORN DR
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-4012
Mailing Address - Country:US
Mailing Address - Phone:405-820-0906
Mailing Address - Fax:
Practice Address - Street 1:3300 TRI CITY DR
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-6599
Practice Address - Country:US
Practice Address - Phone:405-387-3404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist