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General NPI Number Information
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NPI Number | 1023394301
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Entity Type | Individual
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Provider Name | JEFF W WADE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/31/2011
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Last Update Date | 01/02/2023
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Provider Practice Location Address
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Address Line | 950 E KENOSHA ST
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City | BROKEN ARROW
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State | OK
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Zip | 74012-2071
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Country | US
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Telephone | 918-251-3996
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Fax |
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Provider Business Mailing Address
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Address Line | 10018 S YALE AVE
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City | TULSA
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State | OK
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Zip | 74137-6016
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Country | US
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Telephone | 918-298-2467
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Fax | 918-298-8541
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 14134
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License Number State | OK
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