Healthcare Provider Details

I. General information

NPI: 1609153840
Provider Name (Legal Business Name): CARL BENJAMIN WREN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 S LEWIS AVE
TULSA OK
74104-4624
US

IV. Provider business mailing address

1440 S LEWIS AVE
TULSA OK
74104-4624
US

V. Phone/Fax

Practice location:
  • Phone: 918-747-6429
  • Fax:
Mailing address:
  • Phone: 918-747-6429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14785
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: