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General NPI Number Information
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NPI Number | 1225707276
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Entity Type | Individual
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Provider Name | MOSES NIMO PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 09/12/2021
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Last Update Date | 09/12/2021
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Provider Practice Location Address
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Address Line | 5046 S SHERIDAN RD
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City | TULSA
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State | OK
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Zip | 74145-5714
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Country | US
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Telephone | 918-627-6464
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Fax |
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Provider Business Mailing Address
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Address Line | 4414 W MADISON PL
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City | BROKEN ARROW
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State | OK
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Zip | 74012-8542
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Country | US
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Telephone | 918-406-0826
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 19381
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License Number State | OK
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