Provider Demographics
NPI:1255612453
Name:REED ELDER, FERN L (RPH)
Entity type:Individual
Prefix:
First Name:FERN
Middle Name:L
Last Name:REED ELDER
Suffix:
Gender:F
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:HC 65 BOX 165
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OK
Mailing Address - Zip Code:73724-9401
Mailing Address - Country:US
Mailing Address - Phone:580-886-3367
Mailing Address - Fax:580-886-3367
Practice Address - Street 1:10 W 15TH ST
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2445
Practice Address - Country:US
Practice Address - Phone:620-624-5334
Practice Address - Fax:620-624-5096
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-15083183500000X
OK9677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist