Provider Demographics
NPI:1265590582
Name:VEACH, PAULA M
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:M
Last Name:VEACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 BOWERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-7704
Mailing Address - Country:US
Mailing Address - Phone:405-222-5347
Mailing Address - Fax:
Practice Address - Street 1:130 BOWERWOOD DR
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-7704
Practice Address - Country:US
Practice Address - Phone:405-222-5347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10830183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10830OtherPHARMACY LICENSE