Individual
MRS. DEBRA J POLK-MAUTERER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPH.
Contact information
Practice address
1041 SW 19TH ST, MOORE, OK 73160-2806
(405) 793-1803
Mailing address
3805 NW PIONEER ST, NORMAN, OK 73072-1245
(405) 329-6090
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12040
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100243890D
—
OK
Enumeration date
09/13/2011
Last updated
09/13/2011
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