Provider Demographics
NPI:1821185695
Name:WRIGHT, MARY LAWSON (DPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LAWSON
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 W. TOLEDO ST.
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-6060
Mailing Address - Country:US
Mailing Address - Phone:918-459-0728
Mailing Address - Fax:
Practice Address - Street 1:4909 E. 41ST ST.
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135
Practice Address - Country:US
Practice Address - Phone:918-270-7060
Practice Address - Fax:918-270-7069
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist