Healthcare Provider Details

I. General information

NPI: 1780520296
Provider Name (Legal Business Name): JENNIFER LE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

12709 PREAKNESS RD
OKLAHOMA CITY OK
73173-8884
US

V. Phone/Fax

Practice location:
  • Phone: 572-243-2130
  • Fax:
Mailing address:
  • Phone: 405-826-2321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number16176
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number16176
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: