Individual
IVANA IVANOVIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5046 S SHERIDAN RD, TULSA, OK 74145
(918) 627-6464
Mailing address
5046 S SHERIDAN RD, TULSA, OK 74145-5714
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
18135
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18135
OKLAHOMA BOARD OF PHARMACY
OK
Enumeration date
08/17/2020
Last updated
08/17/2020
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