Provider Demographics
NPI:1861772345
Name:VANVEKOVEN, DIANNE MICHELLE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:MICHELLE
Last Name:VANVEKOVEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E CARL ALBERT PKWY
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5121
Mailing Address - Country:US
Mailing Address - Phone:918-424-5479
Mailing Address - Fax:918-429-0794
Practice Address - Street 1:1000 E CARL ALBERT PKWY
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5121
Practice Address - Country:US
Practice Address - Phone:918-424-5479
Practice Address - Fax:918-429-0794
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist