Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MITCHELL ALLY WALLIS
Active Sole ProprietorPharmacist · BROKEN BOW, OK
Registration Details
- NPI Number
- 1528925104
- Provider Type
- Individual
- Gender
- Unknown
- NPI Issued
- Jan 6, 2026 (0.28935133834773 yrs)
- Last Updated
- Jan 6, 2026
- License
-
21050 (OK)
- Sole Proprietor
- Yes
Practice Information
- Address
-
802 N PARK DRBROKEN BOW, OK, 747282146Browse OK providers · Browse ZIP 74728
- Phone
- 5805842850
- Fax
- 5805842820
- Primary Specialty
-
Pharmacist
183500000X
Other Pharmacist Providers in BROKEN BOW, OK
| Name | Credential | NPI |
|---|---|---|
| MS. SHANNON JEWELANNA PRUETT | D.PH. | 1033118286 |
| DR. EDDIE D ALLEN | DPH | 1073675732 |
| LINDSEY O'REAR | PHARMD | 1417359233 |
| KYLE WAYNE GRAY | PHARM. D | 1427523729 |
| AMY KORINNE HAMMONDS | DPH | 1790256360 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.