Individual
LISA FILLMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1007 N COUNTRY CLUB RD, ADA, OK 74820-2847
(580) 421-6260
(580) 559-0610
Mailing address
1001 N COUNTRY CLUB RD, ADA, OK 74820-2847
(580) 421-4570
(580) 421-6283
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
9926
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9926
OK LICENSE
OK
Enumeration date
10/17/2006
Last updated
07/23/2007
About Stedi
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