Healthcare Provider Details

I. General information

NPI: 1689610172
Provider Name (Legal Business Name): SUSAN WELLS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 09/19/2025
Certification Date: 10/05/2023
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 TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number11-5063
License Number StateOK

VIII. Authorized Official

Name: SUSAN WELLS
Title or Position: OWNER AND PHARMACIST
Credential:
Phone: 918-367-3391