Provider Demographics
NPI:1306056643
Name:KORBER, LISA BRIDGE (PHARMD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:BRIDGE
Last Name:KORBER
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 1:1209 FAIRVIEW FARM RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1333
Mailing Address - Country:US
Mailing Address - Phone:405-945-4400
Mailing Address - Fax:405-945-4407
Practice Address - Street 1:3433 NW 56TH ST
Practice Address - Street 2:140B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4455
Practice Address - Country:US
Practice Address - Phone:405-945-4400
Practice Address - Fax:405-945-4407
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist