Healthcare Provider Details

I. General information

NPI: 1871578005
Provider Name (Legal Business Name): JODI NICOLE SPARKMAN TRICINELLA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S MOORE AVE
CLAREMORE OK
74017-5047
US

IV. Provider business mailing address

5327 S HARVARD AVE
TULSA OK
74135-3869
US

V. Phone/Fax

Practice location:
  • Phone: 918-342-6648
  • Fax: 918-342-6330
Mailing address:
  • Phone: 918-342-6298
  • Fax: 918-342-6330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13700
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: