Bradley Paul Banister, PHARM. D.
Individual provider Active NPI Pharmacist · Mangum, OK
NPI 1164501433 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1164501433
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 13420 (OK)
- Practice address
- 1000 S. Louis Tittle
Mangum, OK 73554 - Phone
- (580) 782-5400
- Fax
- (580) 782-5404
- NPI assigned
- Nov 6, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13420 | OK | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 13420 | OK | Yes |
Addresses
Primary practice location
1000 S. Louis Tittle
Mangum, OK 73554
Mailing address
403 S Robinson Ave
Mangum, OK 73554-4613
Phone (580) 782-2750
Other providers in Mangum, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.