Healthcare Provider Details

I. General information

NPI: 1619786431
Provider Name (Legal Business Name): MARIGONA MISINI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W STATE HIGHWAY 152
MUSTANG OK
73064-3902
US

IV. Provider business mailing address

10025 SW 23RD ST
YUKON OK
73099-5121
US

V. Phone/Fax

Practice location:
  • Phone: 405-376-3340
  • Fax:
Mailing address:
  • Phone: 405-384-0371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20815
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: