Individual
CHARLES BRENT BUSHNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3414 S YALE AVE STE F, TULSA, OK 74135-8020
(918) 749-4200
Mailing address
6906 E 75TH CT, TULSA, OK 74133-3032
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12675
OK
Other
Enumeration date
08/11/2006
Last updated
07/08/2007
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