Provider Demographics
NPI:1932481843
Name:PHIPPS, TERESA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N 193 E AVE
Mailing Address - Street 2:
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015
Mailing Address - Country:US
Mailing Address - Phone:918-266-8837
Mailing Address - Fax:918-266-1512
Practice Address - Street 1:315 N 193RD EAST AVE
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-2862
Practice Address - Country:US
Practice Address - Phone:918-266-8837
Practice Address - Fax:918-266-1512
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13873183500000X
ARPD10758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist