Individual
KATTIE ELLEN SISCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
4704 S ELM PL, BROKEN ARROW, OK 74011-3220
(918) 455-8308
Mailing address
4704 S ELM PL, BROKEN ARROW, OK 74011-3220
(918) 455-8308
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
17670
OK
Other
Enumeration date
03/14/2018
Last updated
03/14/2018
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