Provider Demographics
NPI:1164993846
Name:WESSELS, ADRIENNE (PHARM D)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:WESSELS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:OK
Mailing Address - Zip Code:73728-2028
Mailing Address - Country:US
Mailing Address - Phone:580-596-2411
Mailing Address - Fax:580-596-2471
Practice Address - Street 1:121 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:OK
Practice Address - Zip Code:73728-2028
Practice Address - Country:US
Practice Address - Phone:580-596-2411
Practice Address - Fax:580-596-2471
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist