Provider Demographics
NPI:1053397190
Name:CHIOVOLONI, IVANNE LYNNE (PHARMD, NCPS, BCPS)
Entity type:Individual
Prefix:DR
First Name:IVANNE
Middle Name:LYNNE
Last Name:CHIOVOLONI
Suffix:
Gender:F
Credentials:PHARMD, NCPS, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1069
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-1069
Mailing Address - Country:US
Mailing Address - Phone:918-207-3987
Mailing Address - Fax:
Practice Address - Street 1:855 MARKOMA CIRCLE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464
Practice Address - Country:US
Practice Address - Phone:918-207-3987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK131611835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy