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NPI Code Detail

MEDICARE: DR. DIANNE MICHELLE VANVEKOVEN PHARM. D

MEDICARE: DR. DIANNE MICHELLE VANVEKOVEN PHARM. D
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
1183500000XPharmacist13908OK

General Provider Information

NPI Number : 1861772345
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIANNE MICHELLE VANVEKOVEN PHARM. D
Provider Business Mailing Address
First Line : 1000 E CARL ALBERT PKWY
Second Line :
City : MCALESTER
State : OK
Zip : 74501-5121
Country : US
Telephone Number : 918-424-5479
Fax Number : 918-429-0794
Provider Business Practice Location Address
First Line : 1000 E CARL ALBERT PKWY
Second Line :
City : MCALESTER
State : OK
Zip : 74501-5121
Country : US
Telephone Number : 918-424-5479
Fax Number : 918-429-0794
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2011
Last Update Date : 08/28/2011

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