Healthcare Provider Details

I. General information

NPI: 1528617834
Provider Name (Legal Business Name): VAPORHERBS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 S MAIN ST
SAPULPA OK
74066-5401
US

IV. Provider business mailing address

921 S MAIN ST
SAPULPA OK
74066-5401
US

V. Phone/Fax

Practice location:
  • Phone: 918-289-8526
  • Fax:
Mailing address:
  • Phone: 918-289-8526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: BECKY ROPER
Title or Position: OWNER
Credential:
Phone: 918-289-8526