Provider Demographics
NPI:1457087330
Name:PRISE, LEITH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LEITH
Middle Name:
Last Name:PRISE
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 1:2816 BROMPTON DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2233
Mailing Address - Country:US
Mailing Address - Phone:405-412-3626
Mailing Address - Fax:
Practice Address - Street 1:3435 NW 56TH ST STE 101
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4495
Practice Address - Country:US
Practice Address - Phone:405-951-2377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist