Organization
DENNIS WAGNER
Active
Other names
WESTERN OAKS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS WAGNER (OWNER)
(405) 789-6881
Entity
Organization
Contact information
Practice address
2703 N ROCKWELL AVE, BETHANY, OK 73008-5246
(405) 789-6881
(405) 787-9793
Mailing address
2703 N ROCKWELL AVE, BETHANY, OK 73008-5246
(405) 789-6881
(405) 787-9793
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
1-4168
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100236840A
—
OK
05
—
100805600B
—
OK
01
—
2072645
PK
—
Enumeration date
11/14/2006
Last updated
05/20/2015
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