Healthcare Provider Details

I. General information

NPI: 1225209182
Provider Name (Legal Business Name): RONALD DEAN HULETT D.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6336 E 4TH PL
TULSA OK
74112-1727
US

IV. Provider business mailing address

6336 E 4TH PL
TULSA OK
74112-1727
US

V. Phone/Fax

Practice location:
  • Phone: 918-833-5180
  • Fax: 918-835-2993
Mailing address:
  • Phone: 918-833-5180
  • Fax: 918-835-2993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9627
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: