Healthcare Provider Details

I. General information

NPI: 1538231683
Provider Name (Legal Business Name): REBECCA LYNNE SMITH PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 E CLEVELAND AVE
SAPULPA OK
74066
US

IV. Provider business mailing address

461 E 142ND PL
GLENPOOL OK
74033-3582
US

V. Phone/Fax

Practice location:
  • Phone: 918-224-9310
  • Fax: 918-756-2464
Mailing address:
  • Phone: 918-277-2103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number13878
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number13878
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13878
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: