Healthcare Provider Details

I. General information

NPI: 1013512862
Provider Name (Legal Business Name): OSARETIN FESTUS OGBEIFUN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6342 E ADMIRAL PL
TULSA OK
74115-8626
US

IV. Provider business mailing address

6342 E ADMIRAL PL
TULSA OK
74115-8626
US

V. Phone/Fax

Practice location:
  • Phone: 918-836-1715
  • Fax: 918-836-8050
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18094
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: