Individual
MR. MARK JAMES WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DOCTOR OF PHARMACY
Contact information
Practice address
301 S SANTE FE AVE, EDMOND, OK 73003
(405) 330-6093
(405) 330-6153
Mailing address
301 S SANTE FE AVE, EDMOND, OK 73003
(405) 330-6093
(405) 330-6153
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11913
OK
Other
Enumeration date
10/06/2011
Last updated
10/06/2011
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