Provider Demographics
NPI:1366517575
Name:OWENS, LISA AILEEN (DPH)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:AILEEN
Last Name:OWENS
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 1:2300 W WACO ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-1509
Mailing Address - Country:US
Mailing Address - Phone:918-455-5513
Mailing Address - Fax:
Practice Address - Street 1:7302 S YALE AVE STE 101
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136
Practice Address - Country:US
Practice Address - Phone:918-392-3366
Practice Address - Fax:918-392-2950
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK104971835P1300X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric