Individual
JERRY W WAYMIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPH,PD
Contact information
Practice address
2219 N BROADWAY ST, POTEAU, OK 74953-2007
(918) 647-9531
(918) 647-5247
Mailing address
2219 N BROADWAY AVE, POTEAU, OK 74953
(918) 647-9531
(918) 647-5247
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
6548
AR
183500000X
Pharmacist
Primary
9314
OK
Other
Enumeration date
04/08/2010
Last updated
04/08/2010
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