Provider Demographics
NPI:1689224453
Name:LORG, KRYSTIN I (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KRYSTIN
Middle Name:
Last Name:LORG
Suffix:I
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 1:15400 TURTLE LAKE PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73165-5604
Mailing Address - Country:US
Mailing Address - Phone:405-808-8400
Mailing Address - Fax:
Practice Address - Street 1:224 S CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5223
Practice Address - Country:US
Practice Address - Phone:405-808-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK146911835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy