Provider Demographics
NPI:1205183837
Name:GRIMES, LEZLIE A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LEZLIE
Middle Name:A
Last Name:GRIMES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6909 S PEACH AVE.
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011
Mailing Address - Country:US
Mailing Address - Phone:405-627-2556
Mailing Address - Fax:
Practice Address - Street 1:5046 S SHERIDAN
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145
Practice Address - Country:US
Practice Address - Phone:918-627-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist