Healthcare Provider Details

I. General information

NPI: 1376203455
Provider Name (Legal Business Name): SAVANNAH PETERSON PHARM D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15951 LITTLE AXE DR
NORMAN OK
73026-9088
US

IV. Provider business mailing address

900 SAINT CECIL
MOORE OK
73160-2536
US

V. Phone/Fax

Practice location:
  • Phone: 405-292-9530
  • Fax:
Mailing address:
  • Phone: 405-760-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19341
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: