Provider Demographics
NPI:1487412540
Name:THOMAS, LORISSA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LORISSA
Middle Name:
Last Name:THOMAS
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 1:601 E VICTORIA TER
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-9474
Mailing Address - Country:US
Mailing Address - Phone:405-881-8794
Mailing Address - Fax:405-653-9445
Practice Address - Street 1:7512 BROADWAY EXT STE 308
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9055
Practice Address - Country:US
Practice Address - Phone:405-212-5669
Practice Address - Fax:405-653-9445
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK137301835C0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0207XPharmacy Service ProvidersPharmacistCompounded Sterile Preparations