Individual
MRS. LISA R TYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPH
Contact information
Practice address
RT 6, 840, STILWELL, OK 74960
(918) 696-8800
Mailing address
131 EUBANKS, TAHLEQUAH, OK 74464-8807
(918) 458-1006
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11619
OK
Other
Enumeration date
03/11/2011
Last updated
03/11/2011
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