Individual
BRAVEN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPH
Contact information
Practice address
1440 S LEWIS AVE, TULSA, OK 74104-4624
(918) 747-6429
Mailing address
1440 S LEWIS AVE, TULSA, OK 74104-4624
(918) 747-6429
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
15790
OK
Other
Enumeration date
07/10/2015
Last updated
07/10/2015
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