Individual
JAMES MARK WALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.PH.
Contact information
Practice address
1099 GARTH BROOKS BLVD, YUKON, OK 73099-4104
(405) 350-1251
Mailing address
1099 GARTH BROOKS BLVD, YUKON, OK 73099-4104
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10348
OK
Other
Enumeration date
10/21/2011
Last updated
10/21/2011
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