Individual
MR. WYATT EVANS LIVELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.PH.
Contact information
Practice address
128 E CHEROKEE AVE, NOWATA, OK 74048-2702
(918) 273-3825
(918) 273-2251
Mailing address
128 E CHEROKEE AVE, NOWATA, OK 74048-2702
(918) 273-3825
(918) 273-2251
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
18327
OK
Other
Enumeration date
07/18/2019
Last updated
07/18/2019
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