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General NPI Number Information
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NPI Number | 1891807590
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Entity Type | Individual
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Provider Name | JEREMY LEE MYERS DPH
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6120 E 71ST ST
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City | TULSA
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State | OK
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Zip | 74136-6734
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Country | US
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Telephone | 918-491-9898
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Fax | 918-494-4793
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Provider Business Mailing Address
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Address Line | 14004 E 136TH ST N
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City | COLLINSVILLE
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State | OK
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Zip | 74021-3648
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Country | US
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Telephone | 918-491-9898
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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 | 12347
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License Number State | OK
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