Individual
BRAIN FUBI NIBA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
9000 S MAY AVE, OKLAHOMA CITY, OK 73159-6602
(405) 691-1148
(405) 691-5426
Mailing address
13704 S BROOKLINE AVE, OKLAHOMA CITY, OK 73170-2098
(405) 549-6162
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
18541
OK
Other
Enumeration date
09/28/2022
Last updated
09/28/2022
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