Individual
TYLER WELLHAUSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
409 N HWY 102, MCLOUD, OK 74851
(405) 964-2081
(405) 964-5968
Mailing address
PO BOX 1059, MCLOUD, OK 74851-1059
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
14102
OK
Other
Enumeration date
07/28/2008
Last updated
07/28/2008
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