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Individual

SHELO JUSTINE MUTZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
D.PH.

Contact information

Practice address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 458-3105
(918) 458-3508
Mailing address
509 RANSTEN ST, TAHLEQUAH, OK 74464-4186
(918) 453-2750

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11832
OK

Other

Enumeration date
06/26/2008
Last updated
06/26/2008
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