Provider Demographics
NPI:1053950063
Name:LABOSSIERE, ALEXANDER WILLIAM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:WILLIAM
Last Name:LABOSSIERE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1738
Mailing Address - Country:US
Mailing Address - Phone:580-765-3055
Mailing Address - Fax:
Practice Address - Street 1:2701 N 14TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1738
Practice Address - Country:US
Practice Address - Phone:580-765-3055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist