Provider Demographics
NPI:1609114875
Name:BISHOP, TOMMY JOE (DPH)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:JOE
Last Name:BISHOP
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6001
Mailing Address - Country:US
Mailing Address - Phone:405-321-2838
Mailing Address - Fax:405-329-3518
Practice Address - Street 1:222 ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6001
Practice Address - Country:US
Practice Address - Phone:405-321-2838
Practice Address - Fax:405-329-3518
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist