Individual
MR. JACK LEE JUSTICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPH
Contact information
Practice address
110 BURR AVE, PAULS VALLEY, OK 73075-3848
(405) 238-7391
(405) 238-1162
Mailing address
110 BURR AVE, PAULS VALLEY, OK 73075-3848
(405) 238-7391
(405) 238-1162
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
8244
OK
Other
Enumeration date
11/10/2006
Last updated
07/08/2007
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