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Individual

MRS. CHERYL WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DPH

Contact information

Practice address
1800 S WOOD DR, OKMULGEE, OK 74447-6826
(918) 756-9646
Mailing address
2919 W 118TH PL S, JENKS, OK 74037-5902

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10794
OK

Other

Enumeration date
10/28/2020
Last updated
10/28/2020
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