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Individual

MS. SHANNON JEWELANNA PRUETT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
D.PH.

Contact information

Practice address
201 S PARK DR, BROKEN BOW, OK 74728-4737
(580) 584-6085
(580) 584-6088
Mailing address
692 OLD MILITARY ROAD, BROKEN BOW, OK 74728-9659
(580) 584-6089

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12491
OK

Other

Enumeration date
07/19/2005
Last updated
01/31/2021
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