Individual
MR. BRYAN L GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPH
Contact information
Practice address
262 E 141ST ST, GLENPOOL, OK 74033-3569
(918) 322-3667
(918) 322-5923
Mailing address
PO BOX 887, GLENPOOL, OK 74033-0887
(918) 322-3667
(918) 322-5923
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10425
OK
Other
Enumeration date
02/05/2021
Last updated
02/05/2021
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