Individual
MR. MICKIE DEAN CHARMASSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
2116 OKLAHOMA AVE, WOODWARD, OK 73801-4258
(580) 254-3504
Mailing address
2116 OKLAHOMA AVE, WOODWARD, OK 73801-4258
(580) 254-3504
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
9611
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
183500000X
—
OK
Enumeration date
06/21/2019
Last updated
06/21/2019
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