Individual
DR. BRADLEY PAUL BANISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM. D.
Contact information
Practice address
1000 S. LOUIS TITTLE, MANGUM, OK 73554
(580) 782-5400
(580) 782-5404
Mailing address
403 S ROBINSON AVE, MANGUM, OK 73554-4613
(580) 782-2750
(580) 782-5404
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13420
OK
Other
Enumeration date
11/06/2006
Last updated
07/08/2007
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