Provider Demographics
NPI:1083995559
Name:HARM, MIMI WHITEHEAD
Entity Type:Individual
Prefix:
First Name:MIMI
Middle Name:WHITEHEAD
Last Name:HARM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S LAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-6141
Mailing Address - Country:US
Mailing Address - Phone:405-326-8121
Mailing Address - Fax:
Practice Address - Street 1:808 N PORTER
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6403
Practice Address - Country:US
Practice Address - Phone:405-321-1445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist