Individual
MYLLA JAYLYNN WICKWIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM.D.
Contact information
Practice address
5252 N MERIDIAN AVE, OKLAHOMA CITY, OK 73112-2178
(405) 880-8888
(405) 992-0561
Mailing address
8921 BOBWHITE RD, YUKON, OK 73099-8456
(405) 467-4208
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
14083
OK
Other
Enumeration date
09/15/2008
Last updated
06/11/2019
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