Individual
JARED MILLER WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
9411 S DELAWARE AVE, TULSA, OK 74137-5614
(918) 299-5764
Mailing address
9411 S DELAWARE AVE, TULSA, OK 74137-5614
(918) 299-5764
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
14505
OK
Other
Enumeration date
11/02/2020
Last updated
11/02/2020
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