Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mitchell Ally Wallis

Individual provider Pharmacist · NPI 1528925104

Mitchell Ally Wallis is a Pharmacist in Broken Bow, Oklahoma. Practices as a sole proprietor. Licensed in Oklahoma.

Licensed in
OK
In the registry since
2026

Practice location Address checks out

802 N Park Dr
Broken Bow, OK 74728-2146
Phone: (580) 584-2850
Fax: (580) 584-2820
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pharmacist (primary) Taxonomy 183500000X · Licence 21050 (OK)

Record details

NPI number1528925104
Entity typeIndividual (Type 1)
GenderNot disclosed
Sole proprietorYes
NPI enumeratedJanuary 6, 2026
Last updated in NPPESJanuary 6, 2026
Certification dateJanuary 6, 2026
Mailing address104 W Sherry Ln, Broken Bow, OK 74728-1726

Other providers in Broken Bow