MEDICARE: MICHAEL BRENT BISHOP DOCTOR OF PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	15679	OK

General Provider Information

NPI Number	:	1528668928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL BRENT BISHOP DOCTOR OF PHARMACY

Provider Business Mailing Address
First Line	:	13503 S SANTA FE AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-7314
Country	:	US
Telephone Number	:	405-300-6418
Fax Number	:	405-300-6417

Provider Business Practice Location Address
First Line	:	13503 S SANTA FE AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-7314
Country	:	US
Telephone Number	:	405-300-6418
Fax Number	:	405-300-6417

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2020
Last Update Date	:	10/27/2020

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