Healthcare Provider Details

I. General information

NPI: 1891408076
Provider Name (Legal Business Name): SUSAN WELLS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N MAIN ST
BRISTOW OK
74010-2407
US

IV. Provider business mailing address

215 N MAIN ST
BRISTOW OK
74010-2407
US

V. Phone/Fax

Practice location:
  • Phone: 918-367-3391
  • Fax: 918-367-3392
Mailing address:
  • Phone: 918-367-3391
  • Fax: 918-367-3392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13032
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: