Provider Demographics
NPI:1255802807
Name:CUADERES, PHYLLIS RENEE (DPH)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:RENEE
Last Name:CUADERES
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11116 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-2038
Mailing Address - Country:US
Mailing Address - Phone:918-970-4919
Mailing Address - Fax:918-970-2790
Practice Address - Street 1:11116 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-2038
Practice Address - Country:US
Practice Address - Phone:918-970-4919
Practice Address - Fax:918-970-2790
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist