Provider Demographics
NPI:1760077291
Name:ISIAHO, ARMSTRONG M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ARMSTRONG
Middle Name:M
Last Name:ISIAHO
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 1:4504 KELLYE GREEN ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1453
Mailing Address - Country:US
Mailing Address - Phone:405-532-3150
Mailing Address - Fax:
Practice Address - Street 1:4504 KELLYE GREEN ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1453
Practice Address - Country:US
Practice Address - Phone:405-532-3150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-06
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist