Individual
ABANTI DE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMACIST
Contact information
Practice address
5104 S LEWIS AVE, TULSA, OK 74105-6542
(918) 747-8841
Mailing address
9103 S 72ND EAST AVE, TULSA, OK 74133-5379
(859) 489-9872
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
16038
OK
Other
Enumeration date
11/06/2019
Last updated
11/06/2019
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