=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114937018
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARY WALTER BELL JR. R.PH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2006
-----------------------------------------------------
Last Update Date | 05/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1117 SE FRANK PHILLIPS BLVD
-----------------------------------------------------
City | BARTLESVILLE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74003-4319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-336-2140
-----------------------------------------------------
Fax | 918-336-2145
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1747 MELROSE DR
-----------------------------------------------------
City | BARTLESVILLE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74006-7025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-333-5960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 11230
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------