Provider Demographics
NPI:1295342053
Name:LAMBERT WELCH, JILL ANN (DPH)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:LAMBERT WELCH
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 1:5690 E EVERETTS PT
Mailing Address - Street 2:
Mailing Address - City:OOLOGAH
Mailing Address - State:OK
Mailing Address - Zip Code:74053-3571
Mailing Address - Country:US
Mailing Address - Phone:405-808-5014
Mailing Address - Fax:
Practice Address - Street 1:5690 E EVERETTS PT
Practice Address - Street 2:
Practice Address - City:OOLOGAH
Practice Address - State:OK
Practice Address - Zip Code:74053-3571
Practice Address - Country:US
Practice Address - Phone:405-808-5014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist