Provider Demographics
NPI:1770280414
Name:ZAMBRANO, LISA (DPH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ZAMBRANO
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 PLEASANT VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-1521
Mailing Address - Country:US
Mailing Address - Phone:405-570-7069
Mailing Address - Fax:
Practice Address - Street 1:506 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-0400
Practice Address - Country:US
Practice Address - Phone:405-253-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist