Provider Demographics
NPI:1013916824
Name:CAIN, LOLA L (DPH)
Entity type:Individual
Prefix:DR
First Name:LOLA
Middle Name:L
Last Name:CAIN
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6113 S INDIAN HILLS RD
Mailing Address - Street 2:
Mailing Address - City:TALALA
Mailing Address - State:OK
Mailing Address - Zip Code:74080-9570
Mailing Address - Country:US
Mailing Address - Phone:918-275-4352
Mailing Address - Fax:
Practice Address - Street 1:101 S MOORE AVE
Practice Address - Street 2:USPHS INDIAN HOSPITAL PHARMACY
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-5047
Practice Address - Country:US
Practice Address - Phone:918-342-6584
Practice Address - Fax:918-342-6330
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK89391835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy