MEDICARE: MRS. JILL LEIGH RATTERMAN R.PH.

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	12125	OK

General Provider Information

NPI Number	:	1538134515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILL LEIGH RATTERMAN R.PH.

Provider Business Mailing Address
First Line	:	4545 N LINCOLN BLVD
Second Line	:	SUITE 124
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73105-3418
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4545 N LINCOLN BLVD
Second Line	:	SUITE 124
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73105-3418
Country	:	US
Telephone Number	:	405-522-7113
Fax Number	:

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	08/01/2007

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