Provider Demographics
NPI:1972794949
Name:LOVELESS, JILL MECHELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:MECHELLE
Last Name:LOVELESS
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 1:12395 ELIZABETH DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-4942
Mailing Address - Country:US
Mailing Address - Phone:405-455-1016
Mailing Address - Fax:
Practice Address - Street 1:2350 N HARPER ST
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020
Practice Address - Country:US
Practice Address - Phone:405-390-3611
Practice Address - Fax:405-390-3670
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13830183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist