Healthcare Provider Details

I. General information

NPI: 1568016327
Provider Name (Legal Business Name): HANNAH JOY HERZOG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15951 LITTLE AXE DR
NORMAN OK
73026-9088
US

IV. Provider business mailing address

15951 LITTLE AXE DR
NORMAN OK
73026-9088
US

V. Phone/Fax

Practice location:
  • Phone: 405-292-9530
  • Fax: 405-701-7930
Mailing address:
  • Phone: 405-292-9530
  • Fax: 405-701-7930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60973579
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR-21321
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: