Individual
MR. JERRY J. SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPH
Contact information
Practice address
RR 2 BOX 93, STILWELL, OK 74960
(918) 696-8800
Mailing address
402 GREENWOOD DR, TAHLEQUAH, OK 74464-4815
(918) 207-7071
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
8893
OK
183500000X
Pharmacist
9041
KS
Other
Enumeration date
09/25/2009
Last updated
09/25/2009
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