Provider Demographics
NPI:1255613675
Name:EARLS, JENNIFER J (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:EARLS
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:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:DUKE
Mailing Address - State:OK
Mailing Address - Zip Code:73532-0004
Mailing Address - Country:US
Mailing Address - Phone:580-679-3821
Mailing Address - Fax:
Practice Address - Street 1:1132 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-3122
Practice Address - Country:US
Practice Address - Phone:580-477-1316
Practice Address - Fax:580-477-2154
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist