Individual
TRISTAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1119 E TULSA AVE, KANSAS, OK 74347-7055
(918) 868-6162
Mailing address
1119 E TULSA AVE, KANSAS, OK 74347-7055
(918) 868-6162
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
15459
OK
Other
Enumeration date
11/30/2018
Last updated
11/30/2018
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