Provider Demographics
NPI:1003315052
Name:CRISP, JOSHUA BRYAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:BRYAN
Last Name:CRISP
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8327
Mailing Address - Country:US
Mailing Address - Phone:918-857-8388
Mailing Address - Fax:
Practice Address - Street 1:1928 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8327
Practice Address - Country:US
Practice Address - Phone:918-857-8388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist