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General NPI Number Information
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NPI Number | 1689224453
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Entity Type | Individual
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Provider Name | KRYSTIN LORG I PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/13/2019
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Last Update Date | 09/13/2019
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Provider Practice Location Address
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Address Line | 224 S CHESTNUT AVE
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City | MOORE
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State | OK
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Zip | 73160-5223
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Country | US
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Telephone | 405-808-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 15400 TURTLE LAKE PL
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City | OKLAHOMA CITY
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State | OK
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Zip | 73165-5604
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Country | US
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Telephone | 405-808-8400
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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 | 14691
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License Number State | OK
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