Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1528925104 Individual Practitioner

Mitchell Ally Wallis

Pharmacist • Broken Bow, OK

Professional Overview & Biography Verified Profile Summary

Mitchell Wallis is a registered healthcare professional specializing in Pharmacist in Broken Bow, OK. Practice services are available at 802 N PARK DR under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

802 N Park Dr

Broken Bow, OK 747282146

Telephone 5805842850
Fax 5805842820
Associated Practice Facility / Clinic
🏢 Simpson Pharmacy, Pllc Facility NPI 1518923887

Specialty Benchmarks & Practice Insights

Comparative analytics for Pharmacist in Broken Bow, OK

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.2 Yrs
Regional Practice Density
7 Specialists

Practicing in Broken Bow, OK (3455 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2026-01-06
Pharmacist Primary Specialty

NUCC Taxonomy Code: 183500000X

State License OK 21050

An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active January 06, 2026

NPI status registered as active in NPPES database

📍
Updated Practice Location January 06, 2026

Registered at 802 N PARK DR, BROKEN BOW, OK 747282146 (Tel: 5805842850)

📍
Updated Business Mailing Address January 06, 2026

Registered at 104 W SHERRY LN, BROKEN BOW, OK 747281726

👤
Provider Name / Credentials Updated January 06, 2026

Recorded as MITCHELL WALLIS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) January 06, 2026

Pharmacist (License #21050 in OK)

🟢
Initial NPI Registration & Enumeration January 06, 2026

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1528925104
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: January 06, 2026
Last Update: January 06, 2026
Sole Proprietor: Yes

Mailing Address

104 W Sherry Ln

Broken Bow, OK 747281726

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.