Individual
QUAJUNE CHANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2316 N ROCKWELL AVE, BETHANY, OK 73008-5852
(405) 440-0342
Mailing address
4317 SW 22ND ST APT 1902, OKLAHOMA CITY, OK 73108-1942
(215) 789-0745
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
I-10733
OK
Other
Enumeration date
12/21/2022
Last updated
01/02/2023
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