Provider Demographics
NPI:1982200507
Name:OBERSTE, CASEY LOGAN (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:LOGAN
Last Name:OBERSTE
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:LOGAN
Other - Last Name:MULLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 W 126TH ST S
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-5202
Mailing Address - Country:US
Mailing Address - Phone:607-372-9039
Mailing Address - Fax:
Practice Address - Street 1:3900 E HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-6713
Practice Address - Country:US
Practice Address - Phone:918-355-1076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK18775OtherOKLAHOMA BOARD OF PHARMACY