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General NPI Number Information
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NPI Number | 1346230828
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Entity Type | Individual
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Provider Name | JONATHAN DAVID FERENCE PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 10/25/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1111 SOUTH ST. LOUIS AVE
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City | TULSA
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State | OK
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Zip | 74120-0000
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Country | US
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Telephone | 918-619-4702
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Fax |
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Provider Business Mailing Address
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Address Line | 4502 EAST 41ST STREET SUITE 2H25
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City | JENKS
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State | OK
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Zip | 74135-2512
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Country | US
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Telephone | 918-660-3005
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 13525
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License Number State | OK
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