Individual
BERNIE B WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
324 W BROADWAY ST, OKEMAH, OK 74859-2608
(918) 623-1771
(918) 623-0238
Mailing address
324 W BROADWAY ST, OKEMAH, OK 74859-2608
(918) 623-1036
(918) 623-0238
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
8862
OK
Other
Enumeration date
01/23/2007
Last updated
07/08/2007
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