Provider Demographics
NPI:1700488202
Name:LIKENS, NAOMA C
Entity type:Individual
Prefix:
First Name:NAOMA
Middle Name:C
Last Name:LIKENS
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 1:640 SE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-6733
Mailing Address - Country:US
Mailing Address - Phone:405-794-3581
Mailing Address - Fax:405-794-3743
Practice Address - Street 1:640 SE 4TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-6733
Practice Address - Country:US
Practice Address - Phone:405-794-3581
Practice Address - Fax:405-794-3743
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist