Provider Demographics
NPI:1649551508
Name:ROOF, JOHNA K (DPH)
Entity type:Individual
Prefix:
First Name:JOHNA
Middle Name:K
Last Name:ROOF
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:PO BOX 2090
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-8090
Mailing Address - Country:US
Mailing Address - Phone:580-302-6500
Mailing Address - Fax:580-302-6501
Practice Address - Street 1:1315 N WASHINGTON ST STE 3
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-2443
Practice Address - Country:US
Practice Address - Phone:580-302-6500
Practice Address - Fax:580-302-6501
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11791183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist