Individual
TONI FAYE VANDEGRIFT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPH
Contact information
Practice address
527 W 3RD ST, KONAWA, OK 74849-1415
(580) 925-8911
(580) 925-8920
Mailing address
21410 COUNTY ROAD 1553, ADA, OK 74820-1372
(580) 436-6380
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11283
OK
Other
Enumeration date
11/10/2006
Last updated
07/08/2007
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