MEDICARE: DR. MARION DEAN BLOSS DPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	7352	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7352	OTHER	OK	STATE PHARMACY LICENSE

General Provider Information

NPI Number	:	1528103363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARION DEAN BLOSS DPH

Provider Business Mailing Address
First Line	:	24143 HIGHWAY 82
Second Line	:
City	:	PARK HILL
State	:	OK
Zip	:	74451-4011
Country	:	US
Telephone Number	:	918-456-8432
Fax Number	:	918-431-1155

Provider Business Practice Location Address
First Line	:	26245 HIGHWAY 82
Second Line	:
City	:	PARK HILL
State	:	OK
Zip	:	74451-2802
Country	:	US
Telephone Number	:	918-431-0505
Fax Number	:	918-431-1155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. MARION DEAN BLOSS DPH” Practice Location

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