Most Relevant Information
Provider Data
| NPI Number: | 1003554817 |
| Provider Name: | RUSTY WADE LONG |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 19141 |
Most Important Dates
| Enumeration Date: | 05/23/2022 |
| Last Updated: | 05/23/2022 |
Provider Practice Location
432 S GEORGE NIGH EXPY
MCALESTER
OK
745016025
Practice Location Phone/Fax
| Phone: | 9184238060 |
| Fax: | 9184238409 |
Provider Mailing Location
432 S GEORGE NIGH EXPY
MCALESTER
OK
745016025
Provider Mailing Phone/Fax
| Phone: | 9184238060 |
| Fax: |