Healthcare Provider Details

I. General information

NPI: 1649950262
Provider Name (Legal Business Name): STACEY RENEE HARP D.PH., BCGP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 SW 136TH ST
OKLAHOMA CITY OK
73170-6867
US

IV. Provider business mailing address

116 SW 136TH ST
OKLAHOMA CITY OK
73170-6867
US

V. Phone/Fax

Practice location:
  • Phone: 405-401-3884
  • Fax:
Mailing address:
  • Phone: 405-401-3884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number33740
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11803
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number11803
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: