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NPI Code Detail

MEDICARE: DIVINE KULU

MEDICARE: DIVINE KULU
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistI-10103OK

General Provider Information

NPI Number : 1699305912
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIVINE KULU
Provider Business Mailing Address
First Line : 6350 N MACARTHUR BLVD
Second Line :
City : WARR ACRES
State : OK
Zip : 73122-7213
Country : US
Telephone Number : 405-728-8396
Fax Number :
Provider Business Practice Location Address
First Line : 6350 N MACARTHUR BLVD
Second Line :
City : WARR ACRES
State : OK
Zip : 73122-7213
Country : US
Telephone Number : 405-728-8396
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2020
Last Update Date : 09/08/2022

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Directions to “ DIVINE KULU ” Practice Location

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