Provider Demographics
NPI:1336419845
Name:CHAMBERLAIN, KALEB DEWAYNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KALEB
Middle Name:DEWAYNE
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 W WASHBOURNE ST
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:OK
Mailing Address - Zip Code:74346-4205
Mailing Address - Country:US
Mailing Address - Phone:918-253-4271
Mailing Address - Fax:
Practice Address - Street 1:1015 W WASHBOURNE ST
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346-4205
Practice Address - Country:US
Practice Address - Phone:918-253-4271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-01
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKI-7747183500000X
OK15204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist