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NPI Code Detail

MEDICARE: DR. ANNETTE L PHELPS D.PH.

MEDICARE: DR. ANNETTE L PHELPS D.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
1183500000XPharmacist12212OK

General Provider Information

NPI Number : 1548541956
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANNETTE L PHELPS D.PH.
Provider Business Mailing Address
First Line : 1305 W CHEROKEE ST
Second Line :
City : WAGONER
State : OK
Zip : 74467-4625
Country : US
Telephone Number : 918-485-6688
Fax Number : 918-485-6684
Provider Business Practice Location Address
First Line : 1305 W CHEROKEE ST
Second Line :
City : WAGONER
State : OK
Zip : 74467-4625
Country : US
Telephone Number : 918-485-6688
Fax Number : 918-485-6684
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2011
Last Update Date : 08/30/2011

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