Healthcare Provider Details

I. General information

NPI: 1962559583
Provider Name (Legal Business Name): BETHANY UNITED DRUG CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6736 NW 39TH EXPY
BETHANY OK
73008-2647
US

IV. Provider business mailing address

6736 NW 39TH EXPY
BETHANY OK
73008-2647
US

V. Phone/Fax

Practice location:
  • Phone: 405-789-2126
  • Fax: 405-603-7496
Mailing address:
  • Phone: 405-789-2126
  • Fax: 405-603-7496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number12421
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number12421
License Number StateOK

VIII. Authorized Official

Name: DR. CHALMER HADLEY BOWMAN JR.
Title or Position: PRESIDENT
Credential: D.PH
Phone: 405-789-2126