Provider Demographics
NPI:1619572070
Name:VASQUEZ, BIBETH BANARES (RPH)
Entity Type:Individual
Prefix:
First Name:BIBETH
Middle Name:BANARES
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2850
Mailing Address - Country:US
Mailing Address - Phone:918-355-1293
Mailing Address - Fax:
Practice Address - Street 1:2351 N 9TH ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2850
Practice Address - Country:US
Practice Address - Phone:918-355-1293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist