Healthcare Provider Details

I. General information

NPI: 1386736619
Provider Name (Legal Business Name): GENA LEA DUPUS PHARM.D., BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 E 41ST ST 1H17
TULSA OK
74135-2553
US

IV. Provider business mailing address

4502 E 41ST ST 1H17
TULSA OK
74135-2553
US

V. Phone/Fax

Practice location:
  • Phone: 918-660-3018
  • Fax: 918-660-3580
Mailing address:
  • Phone: 918-660-3018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number11940
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: