Healthcare Provider Details

I. General information

NPI: 1013249507
Provider Name (Legal Business Name): MIRANDA BETH HALL D.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S. PEORIA AVENUE INDIAN HEALTH CARE RESOURCE CENTER OF TULSA
TULSA OK
74120-3820
US

IV. Provider business mailing address

550 S. PEORIA AVENUE INDIAN HEALTH CARE RESOURCE CENTER OF TULSA
TULSA OK
74120-3820
US

V. Phone/Fax

Practice location:
  • Phone: 918-588-1900
  • Fax: 918-582-6405
Mailing address:
  • Phone: 918-588-1900
  • Fax: 918-582-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14068
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: