Individual
MR. MYCALE LLOYD SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DR.OF PHARMACY
Contact information
Practice address
328 N 6TH ST, PERRY, OK 73077-6607
(580) 336-2136
Mailing address
808 QUAIL CREEK DR, PERRY, OK 73077-1320
(580) 336-2136
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
7390
OK
Other
Enumeration date
03/19/2007
Last updated
07/08/2007
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