Organization
BETHEL PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AARON KANWHEN (PHARMACY MANAGER)
(918) 505-9650
Entity
Organization
Contact information
Practice address
205 E PINE ST STE 7, TULSA, OK 74106-4859
(918) 505-9650
(918) 518-7182
Mailing address
205 E PINE ST STE 7, TULSA, OK 74106-4859
(918) 505-9650
(918) 518-7182
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2-6814
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200570490A
—
OK
01
—
2147863
PK
—
Enumeration date
08/19/2014
Last updated
04/04/2017
Update your record
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