Jesse Anderson
Individual provider Active NPI Pharmacy Technician · Ada, OK
NPI 1497835474 · NPPES record last updated Jul 20, 2007
Key facts
- NPI
- 1497835474
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacy Technician 183700000X
- License
- 7289 (OK)
- Practice address
- 1001 N Country Club Rd
Ada, OK 74820-2847 - Phone
- (580) 421-4570
- Fax
- (580) 421-6283
- NPI assigned
- Oct 16, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7289 | OK | MD | Oral and Maxillofacial Surgery (Dentist) |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 7289 | OK | Yes |
Addresses
Primary practice location
1001 N Country Club Rd
Ada, OK 74820-2847
Mailing address
1001 N Country Club Rd
Ada, OK 74820-2847
Phone (580) 421-4570
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7289 | Other | OK | OK LICENSE |
Other providers in Ada, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.