Individual
CONSTANCE REBECCA DIMOND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
251 SOUTH HWY 97, SAND SPRINGS, OK 74063
(918) 246-9570
Mailing address
251 SOUTH HWY 97, SAND SPRINGS, OK 74063
(918) 246-9570
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
15842
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15842
STATE LICENSE
OK
Enumeration date
12/08/2017
Last updated
12/08/2017
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