Provider Demographics
NPI:1528668928
Name:BISHOP, MICHAEL BRENT (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRENT
Last Name:BISHOP
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13503 S SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-7314
Mailing Address - Country:US
Mailing Address - Phone:405-300-6418
Mailing Address - Fax:405-300-6417
Practice Address - Street 1:13503 S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-7314
Practice Address - Country:US
Practice Address - Phone:405-300-6418
Practice Address - Fax:405-300-6417
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist