Healthcare Provider Details

I. General information

NPI: 1295237360
Provider Name (Legal Business Name): ASHLEY ZOLLER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 03/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 E HILLSIDE DR
BROKEN ARROW OK
74012-2385
US

IV. Provider business mailing address

519 N 84TH PL
BROKEN ARROW OK
74014-7449
US

V. Phone/Fax

Practice location:
  • Phone: 918-615-1901
  • Fax:
Mailing address:
  • Phone: 918-519-3337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15040
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: