Healthcare Provider Details

I. General information

NPI: 1952946022
Provider Name (Legal Business Name): THE CHILDREN'S CENTER, INC. DBA BETHANY COMMUNITY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 NW 39TH EXPY
BETHANY OK
73008-2646
US

IV. Provider business mailing address

6770 NW 39TH EXPY
BETHANY OK
73008-2646
US

V. Phone/Fax

Practice location:
  • Phone: 405-440-6797
  • Fax: 405-440-6798
Mailing address:
  • Phone: 405-440-6797
  • Fax: 405-440-6798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NICO GOMEZ
Title or Position: CEO
Credential:
Phone: 405-789-6711