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General NPI Number Information
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NPI Number | 1487412540
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Entity Type | Individual
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Provider Name | LORISSA THOMAS PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 03/12/2024
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Last Update Date | 03/12/2024
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Provider Practice Location Address
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Address Line | 7512 BROADWAY EXT STE 308
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-9055
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Country | US
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Telephone | 405-212-5669
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Fax | 405-653-9445
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Provider Business Mailing Address
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Address Line | 601 E VICTORIA TER
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City | MUSTANG
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State | OK
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Zip | 73064-9474
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Country | US
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Telephone | 405-881-8794
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Fax | 405-653-9445
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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 | 1835C0207X
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Taxonomy Name | Compounded Sterile Preparations Pharmacist
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License Number | 13730
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License Number State | OK
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