Individual
ROY MATTOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 458-3100
Mailing address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 458-3100
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
9540
OK
Other
Enumeration date
05/14/2015
Last updated
05/14/2015
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