Individual
CHARLES JASON MUTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.PH.
Contact information
Practice address
2001 S MUSKOGEE AVE, TAHLEQUAH, OK 74464-5454
(918) 456-6103
(918) 456-6118
Mailing address
509 RANSTEN ST, TAHLEQUAH, OK 74464-4186
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11627
OK
Other
Enumeration date
02/26/2019
Last updated
02/26/2019
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