Individual
MARK VAN HOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10109 E 79TH ST, TULSA, OK 74133-4564
(918) 286-5370
Mailing address
7019 S DOGWOOD PL, BROKEN ARROW, OK 74011-2071
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12225
OK
Other
Enumeration date
07/24/2019
Last updated
07/24/2019
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