Individual
DR. BRIAN LEE WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM D.
Contact information
Practice address
1605 MARK WOOD ST, MIDWEST CITY, OK 73130-8454
(405) 605-9956
Mailing address
1605 MARK WOOD ST, MIDWEST CITY, OK 73130-8454
(405) 605-9956
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
14782
OK
Other
Enumeration date
03/29/2011
Last updated
03/29/2011
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