Individual
TARA JALILVAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17850 N PENNSYLVANIA AVE, EDMOND, OK 73012-9097
(405) 341-1142
(405) 341-1297
Mailing address
17850 N PENNSYLVANIA AVE, EDMOND, OK 73012-9097
(405) 341-1142
(405) 341-1297
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
18040
OK
Other
Enumeration date
09/14/2020
Last updated
09/14/2020
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