Provider Demographics
NPI:1346128147
Name:FORBIS, DWIGHT
Entity type:Individual
Prefix:
First Name:DWIGHT
Middle Name:
Last Name:FORBIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 TREATY RD
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:OK
Mailing Address - Zip Code:74730-4522
Mailing Address - Country:US
Mailing Address - Phone:580-980-9999
Mailing Address - Fax:580-371-3313
Practice Address - Street 1:817 E 6TH ST
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-1800
Practice Address - Country:US
Practice Address - Phone:580-371-2361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist