Healthcare Provider Details

I. General information

NPI: 1164944658
Provider Name (Legal Business Name): SAMIE SABET SARVESTANI PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 07/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 E 41ST ST
TULSA OK
74135-2527
US

IV. Provider business mailing address

4502 E 41ST STREET,
TULSA OK
74135-2512
US

V. Phone/Fax

Practice location:
  • Phone: 918-619-4400
  • Fax:
Mailing address:
  • Phone: 918-660-3420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number17518
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number17518
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number17518
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: