Individual
MRS. SHANNAN DENISE WIDEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARM.D.
Contact information
Practice address
701 FOX RUN TRL, EDMOND, OK 73034-7360
(405) 471-1250
Mailing address
701 FOX RUN TRL, EDMOND, OK 73034-7360
(405) 471-1250
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13911
OK
183500000X
Pharmacist
34908
TX
Other
Enumeration date
05/29/2013
Last updated
05/29/2013
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