Healthcare Provider Details

I. General information

NPI: 1700795481
Provider Name (Legal Business Name): DARYLE WAYNE HUDSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 N 9TH ST
BROKEN ARROW OK
74012-2850
US

IV. Provider business mailing address

2351 N 9TH ST
BROKEN ARROW OK
74012-2850
US

V. Phone/Fax

Practice location:
  • Phone: 918-355-1293
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21449
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: