Provider Demographics
NPI:1750506234
Name:EMERY, LISA MARSHALL (DPH)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARSHALL
Last Name:EMERY
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5644 S DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-7326
Mailing Address - Country:US
Mailing Address - Phone:918-605-8156
Mailing Address - Fax:
Practice Address - Street 1:5644 S DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-7326
Practice Address - Country:US
Practice Address - Phone:918-605-8156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9877183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist