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General NPI Number Information
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NPI Number | 1982200507
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Entity Type | Individual
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Provider Name | CASEY LOGAN OBERSTE PHARMD, RPH
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Gender | Female
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Dates
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Enumeration Date | 12/09/2020
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Last Update Date | 05/08/2022
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Provider Practice Location Address
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Address Line | 3900 E HILLSIDE DR
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City | BROKEN ARROW
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State | OK
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Zip | 74014-6713
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Country | US
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Telephone | 918-355-1076
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Fax |
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Provider Business Mailing Address
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Address Line | 220 W 126TH ST S
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City | JENKS
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State | OK
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Zip | 74037-5202
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Country | US
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Telephone | 607-372-9039
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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 | 18775
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License Number State | OK
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