Provider Demographics
NPI:1679174163
Name:ABUESHEH, YOUSEF
Entity Type:Individual
Prefix:
First Name:YOUSEF
Middle Name:
Last Name:ABUESHEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 S ROCKFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-3031
Mailing Address - Country:US
Mailing Address - Phone:469-360-8990
Mailing Address - Fax:
Practice Address - Street 1:1715 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1535
Practice Address - Country:US
Practice Address - Phone:469-360-8990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist