Individual
IDA EURESTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4704 S ELM PL, BROKEN ARROW, OK 74011-3220
(918) 455-8308
Mailing address
6509 E. 84TH ST, TULSA, OK 74133
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12211
OK
Other
Enumeration date
03/02/2012
Last updated
03/02/2012
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