Provider Demographics
NPI:1801166806
Name:COX, LEEANN (DPH)
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:
Last Name:COX
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 1:15 NW DEER RUN TRL
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9508
Mailing Address - Country:US
Mailing Address - Phone:580-536-6859
Mailing Address - Fax:
Practice Address - Street 1:1823 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3644
Practice Address - Country:US
Practice Address - Phone:580-354-9860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist