Provider Demographics
NPI:1770955726
Name:DAM, JOANNA (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:JOANNA
Middle Name:
Last Name:DAM
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 1:7749 S MINGO RD
Mailing Address - Street 2:APT 617
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-3319
Mailing Address - Country:US
Mailing Address - Phone:813-841-6434
Mailing Address - Fax:
Practice Address - Street 1:7749 S MINGO RD
Practice Address - Street 2:APT 617
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-3319
Practice Address - Country:US
Practice Address - Phone:813-841-6434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist