Healthcare Provider Details

I. General information

NPI: 1083017198
Provider Name (Legal Business Name): MELINDA MAY FISHER DPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W MAIN STREET
PRAGUE OK
74864-4501
US

IV. Provider business mailing address

16640 SW 23RD ST
EL RENO OK
73036-9147
US

V. Phone/Fax

Practice location:
  • Phone: 405-567-4000
  • Fax: 405-567-4883
Mailing address:
  • Phone: 405-820-2002
  • Fax: 405-567-4883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10738
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: