Individual
MR. THEODORE MAUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPH
Contact information
Practice address
1923 S UTICA AVE, TULSA, OK 74104-6520
(918) 744-3131
(918) 744-3063
Mailing address
4013 W VICKSBURG ST, BROKEN ARROW, OK 74011-1359
(918) 633-2456
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12846
OK
Other
Enumeration date
08/16/2018
Last updated
08/16/2018
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