Individual
GAYLE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
815 E 6TH STREET, TISHOMINGO, OK 73460
(580) 371-2392
(580) 559-0610
Mailing address
1001 N COUNTRY CLUB RD, ADA, OK 74820-2847
(580) 421-4570
(580) 421-6283
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
6841
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6841
OK LICENSE
OK
Enumeration date
10/16/2006
Last updated
07/20/2007
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