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General NPI Number Information
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NPI Number | 1669136875
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Entity Type | Individual
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Provider Name | LISA JOSEPH PHARMACIST
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Gender | Female
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 112 E STATE HIGHWAY 152
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City | MUSTANG
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State | OK
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Zip | 73064-4402
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Country | US
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Telephone | 405-376-3751
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Fax |
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Provider Business Mailing Address
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Address Line | 3209 WIMBERLEY DR
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City | YUKON
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State | OK
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Zip | 73099-0420
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Country | US
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Telephone |
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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 | 19445
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License Number State | OK
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