Healthcare Provider Details

I. General information

NPI: 1013828177
Provider Name (Legal Business Name): SIMON ERNEST SEBULIBA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 W EDISON ST
TULSA OK
74127-5218
US

IV. Provider business mailing address

2307 W NASHVILLE PL
BROKEN ARROW OK
74012-4725
US

V. Phone/Fax

Practice location:
  • Phone: 918-582-1375
  • Fax: 918-560-9001
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21516
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: