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General NPI Number Information
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NPI Number | 1174088454
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Entity Type | Organization
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Legal Business Name | PHARMACY @ WELLSTON
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Dates
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Enumeration Date | 01/31/2019
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Last Update Date | 01/31/2019
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Provider Practice Location Address
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Address Line | 309 W 2ND ST
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City | WELLSTON
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State | OK
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Zip | 74881-7488
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Country | US
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Telephone | 405-356-4199
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 56
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City | WELLSTON
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State | OK
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Zip | 74881-0056
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | TECHNICIAN/ASSISTANT
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Name | MS. JENNIE SWEETIN-SMITH
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Credential |
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Telephone | 405-356-4199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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