Healthcare Provider Details

I. General information

NPI: 1174750848
Provider Name (Legal Business Name): STEPHANIE DAWN SKILES PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 06/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E WYANDOTTE DRUG WAREHOUSE #6
MCALESTER OK
74501
US

IV. Provider business mailing address

1001 E WYANDOTTE DRUG WAREHOUSE #6
MCALESTER OK
74501
US

V. Phone/Fax

Practice location:
  • Phone: 918-426-3545
  • Fax: 918-426-3585
Mailing address:
  • Phone: 918-426-3545
  • Fax: 918-426-3585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number#13109
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: