Individual
MRS. JANA MCCULLOUGH EVENSEN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
DPH
Contact information
Practice address
1301 E DOWNING ST, TAHLEQUAH, OK 74464-3350
(918) 456-1000
Mailing address
17841 W 879 RD, PARK HILL, OK 74451-2273
(918) 457-5275
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12811
OK
Other
Enumeration date
08/31/2005
Last updated
07/08/2007
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