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General NPI Number Information
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NPI Number | 1366043929
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Entity Type | Individual
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Provider Name | LISA MICHELLE DRIEVER RPH
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Gender | Female
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 3400 W MAIN ST
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City | NORMAN
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State | OK
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Zip | 73072-4808
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Country | US
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Telephone | 405-307-8369
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Fax |
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Provider Business Mailing Address
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Address Line | 6701 84TH ST
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City | NOBLE
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State | OK
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Zip | 73068-7548
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Country | US
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Telephone | 405-226-6447
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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 | 35982
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 12391
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License Number State | OK
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