Individual
MRS. SHELLI DAWN CALDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
301 W GRAND AVE, PONCA CITY, OK 74601-5118
(580) 765-4456
(580) 765-0668
Mailing address
301 W GRAND AVE, PONCA CITY, OK 74601-5118
(580) 765-4456
(580) 765-0668
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
T4184
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100235620
—
OK
Enumeration date
09/27/2006
Last updated
04/30/2021
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