Individual
MIRANDA LEIGH BALEZENTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2115 S MEMORIAL DR, TULSA, OK 74129-2611
(918) 622-5184
Mailing address
1635 S 89TH EAST AVE, TULSA, OK 74112-8251
(918) 645-7183
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
18304
OK
Other
Enumeration date
04/01/2019
Last updated
04/01/2019
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