Provider Demographics
NPI:1265706253
Name:JUNG, DAKOTAH RUSSELL (PHARM D)
Entity type:Individual
Prefix:DR
First Name:DAKOTAH
Middle Name:RUSSELL
Last Name:JUNG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N WATERPLANT RD
Mailing Address - Street 2:
Mailing Address - City:MARLOW
Mailing Address - State:OK
Mailing Address - Zip Code:73055-9289
Mailing Address - Country:US
Mailing Address - Phone:580-606-0629
Mailing Address - Fax:
Practice Address - Street 1:821 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4615
Practice Address - Country:US
Practice Address - Phone:580-255-6292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist