Provider Demographics
NPI:1942634704
Name:OGLESBEE, VANCE J (RPH)
Entity Type:Individual
Prefix:
First Name:VANCE
Middle Name:J
Last Name:OGLESBEE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:75840-1509
Mailing Address - Country:US
Mailing Address - Phone:903-389-2541
Mailing Address - Fax:903-389-8939
Practice Address - Street 1:201 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:TX
Practice Address - Zip Code:75840-1509
Practice Address - Country:US
Practice Address - Phone:903-389-2541
Practice Address - Fax:903-389-8939
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27657183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist