Provider Demographics
NPI:1790155281
Name:BEBOUT, LINDSAY (PHARM D)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:BEBOUT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:COVINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:20447 E 32ND ST S
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-4944
Mailing Address - Country:US
Mailing Address - Phone:918-605-0469
Mailing Address - Fax:
Practice Address - Street 1:1150 E HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2385
Practice Address - Country:US
Practice Address - Phone:918-615-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist