IndividualActive
Mitchell Wallis
NPI 1528925104 · Pharmacist · Broken Bow, OK
Mitchell Wallis is a Pharmacist provider in Broken Bow, OK (NPI 1528925104).
Provider details
- NPI number
- 1528925104
- Entity type
- Individual
- Primary specialty
- PharmacistPharmacy Service Providers
- Sole proprietor
- Yes
- License
- 21050 (OK)
Specialties & taxonomies
Pharmacy Service Providers
Profile Score
Established profile(53/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
Under 1 yr in registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
802 N Park Dr
Broken Bow, OK 74728-2146
Phone: (580) 584-2850
Fax: (580) 584-2820
Street-level locationGet directions
Mailing address
104 W Sherry Ln
Broken Bow, OK 74728-1726
Registry dates
- Enumerated
- 2026-01-06
- Last updated
- 2026-01-06
- Certified
- 2026-01-06
Frequently asked questions
- What is Mitchell Wallis's NPI number?
- Mitchell Wallis's National Provider Identifier (NPI) is 1528925104, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is Mitchell Wallis's specialty?
- Mitchell Wallis is listed in the NPPES registry with a primary specialty of Pharmacist (Pharmacy Service Providers).
- Where is Mitchell Wallis located?
- Mitchell Wallis's practice location on file with NPPES is 802 N Park Dr, Broken Bow, OK 74728-2146.
- What is Mitchell Wallis's phone number?
- The practice phone number listed in the NPPES registry for Mitchell Wallis is (580) 584-2850.
- Is Mitchell Wallis's NPI active?
- Yes — Mitchell Wallis's NPI (1528925104) is active in the NPPES registry as of the last update on 2026-01-06.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.