MEDICARE: ADRIENNE WESSELS PHARM D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	15739	OK

General Provider Information

NPI Number	:	1164993846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE WESSELS PHARM D.

Provider Business Mailing Address
First Line	:	121 S GRAND AVE
Second Line	:
City	:	CHEROKEE
State	:	OK
Zip	:	73728-2028
Country	:	US
Telephone Number	:	580-596-2411
Fax Number	:	580-596-2471

Provider Business Practice Location Address
First Line	:	121 S GRAND AVE
Second Line	:
City	:	CHEROKEE
State	:	OK
Zip	:	73728-2028
Country	:	US
Telephone Number	:	580-596-2411
Fax Number	:	580-596-2471

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2018
Last Update Date	:	12/06/2018

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