Healthcare Provider Details

I. General information

NPI: 1659095057
Provider Name (Legal Business Name): TANIA EYADIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7925 NW EXPRESSWAY
OKLAHOMA CITY OK
73132-1566
US

IV. Provider business mailing address

7925 NW EXPRESSWAY
OKLAHOMA CITY OK
73132-1566
US

V. Phone/Fax

Practice location:
  • Phone: 405-728-1392
  • Fax:
Mailing address:
  • Phone: 405-728-1392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13559
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: