Provider Demographics
NPI:1205963816
Name:MEADOR, WARREN G (BS,DPH)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:G
Last Name:MEADOR
Suffix:
Gender:M
Credentials:BS,DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 BOWMAN
Mailing Address - Street 2:P.O.BOX 1749
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-1749
Mailing Address - Country:US
Mailing Address - Phone:580-243-8932
Mailing Address - Fax:580-526-3275
Practice Address - Street 1:215 W ROGER MILLER BLVD
Practice Address - Street 2:
Practice Address - City:ERICK
Practice Address - State:OK
Practice Address - Zip Code:73645
Practice Address - Country:US
Practice Address - Phone:580-526-3311
Practice Address - Fax:580-526-3275
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK8680OtherOK ST BD OF PHAR REG NUMB