Provider Demographics
NPI:1649950262
Name:HARP, STACEY RENEE (DPH, BCGP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:RENEE
Last Name:HARP
Suffix:
Gender:F
Credentials:DPH, BCGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SW 136TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-6867
Mailing Address - Country:US
Mailing Address - Phone:405-401-3884
Mailing Address - Fax:
Practice Address - Street 1:116 SW 136TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-6867
Practice Address - Country:US
Practice Address - Phone:405-401-3884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX337401835G0303X
OK11803183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No183500000XPharmacy Service ProvidersPharmacist