Healthcare Provider Details

I. General information

NPI: 1154431385
Provider Name (Legal Business Name): RAVINDRA GANDHI D.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W MAIN ST
NORMAN OK
73069-6923
US

IV. Provider business mailing address

6112 W WOODBROOK RD
WARR ACRES OK
73132-6442
US

V. Phone/Fax

Practice location:
  • Phone: 405-364-5665
  • Fax: 405-447-4639
Mailing address:
  • Phone: 405-210-6770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number10254
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: