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General NPI Number Information
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NPI Number | 1124427745
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Entity Type | Organization
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Legal Business Name | BETHEL PHARMACY LLC
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 04/04/2017
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Provider Practice Location Address
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Address Line | 205 E PINE ST STE 7
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City | TULSA
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State | OK
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Zip | 74106-4859
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Country | US
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Telephone | 918-505-9650
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Fax | 918-518-7182
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Provider Business Mailing Address
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Address Line | 205 E PINE ST STE 7
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City | TULSA
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State | OK
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Zip | 74106-4859
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Country | US
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Telephone | 918-505-9650
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Fax | 918-518-7182
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | AARON KANWHEN
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Credential |
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Telephone | 918-505-9650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2-6814
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License Number State | OK
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