Provider Demographics
NPI:1649341710
Name:DAVIS, RONNIE LOGAN (DPH)
Entity type:Individual
Prefix:
First Name:RONNIE
Middle Name:LOGAN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N SCRAPER ST
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-3209
Mailing Address - Country:US
Mailing Address - Phone:918-256-2541
Mailing Address - Fax:918-256-5295
Practice Address - Street 1:201 N SCRAPER ST
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-3209
Practice Address - Country:US
Practice Address - Phone:918-256-2541
Practice Address - Fax:918-256-5295
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist