Healthcare Provider Details

I. General information

NPI: 1639347313
Provider Name (Legal Business Name): JASON ROBERT REVEL PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 NW 72ND ST STE 142
WARR ACRES OK
73132-5924
US

IV. Provider business mailing address

5601 NW 72ND ST STE 142
WARR ACRES OK
73132-5924
US

V. Phone/Fax

Practice location:
  • Phone: 888-773-8266
  • Fax: 888-998-8267
Mailing address:
  • Phone: 888-773-8266
  • Fax: 888-998-8267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-13915
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17446
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2004032893
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: