Provider Demographics
NPI:1942398722
Name:STOCKTON, SHELLY JANET (RPH, PHD)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:JANET
Last Name:STOCKTON
Suffix:
Gender:F
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 3445
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-9332
Mailing Address - Country:US
Mailing Address - Phone:405-694-3190
Mailing Address - Fax:580-774-7020
Practice Address - Street 1:900 N PORTER AVE STE 101
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6426
Practice Address - Country:US
Practice Address - Phone:405-364-5222
Practice Address - Fax:405-364-7076
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0243740002Medicare ID - Type UnspecifiedPART A, B, AND DME