Individual
DARREN TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPH
Contact information
Practice address
225 W MAIN ST, WILBURTON, OK 74578-4045
(918) 465-9300
(918) 465-9303
Mailing address
225 W MAIN ST, WILBURTON, OK 74578-4045
(918) 465-9300
(918) 465-9303
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11475
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200081170A
—
OK
05
—
200081170B
—
OK
Enumeration date
06/24/2009
Last updated
03/05/2021
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