Individual
DR. BENJAMIN WAYNE DALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11 W TAFT AVE, SAPULPA, OK 74066-5430
(918) 227-0878
(918) 227-1193
Mailing address
2009 W 120TH ST S, JENKS, OK 74037-2990
(918) 298-4072
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13067
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100245420A
—
OK
Enumeration date
10/03/2011
Last updated
10/03/2011
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