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General NPI Number Information
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NPI Number | 1831470368
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Entity Type | Individual
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Provider Name | REBECCA L BOUSE PHARM.D
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Gender | Female
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Dates
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Enumeration Date | 08/29/2011
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Last Update Date | 03/20/2020
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Provider Practice Location Address
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Address Line | 3300 TRI CITY DR
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City | NEWCASTLE
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State | OK
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Zip | 73065-6599
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Country | US
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Telephone | 405-387-3404
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Fax |
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Provider Business Mailing Address
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Address Line | 3265 STAGHORN DR
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City | BLANCHARD
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State | OK
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Zip | 73010-4012
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Country | US
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Telephone | 405-820-0906
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 13311
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License Number State | OK
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