Provider Demographics
NPI:1932709060
Name:SNELL, LEONIE (DPH)
Entity Type:Individual
Prefix:
First Name:LEONIE
Middle Name:
Last Name:SNELL
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 1:84127 HIGHWAY 59
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-4257
Mailing Address - Country:US
Mailing Address - Phone:918-696-3186
Mailing Address - Fax:918-696-3285
Practice Address - Street 1:84127 HIGHWAY 59
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-4257
Practice Address - Country:US
Practice Address - Phone:918-696-3186
Practice Address - Fax:918-696-3285
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist