Provider Demographics
NPI:1437406501
Name:BULLOCK, LANCE (PHARM D)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:BULLOCK
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8449 E 81ST ST APT 318
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-8046
Mailing Address - Country:US
Mailing Address - Phone:580-302-0628
Mailing Address - Fax:
Practice Address - Street 1:3112 S HARVARD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-4403
Practice Address - Country:US
Practice Address - Phone:918-742-2216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist