Bethel Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2-6814 Issued in OK

Legal business name

BETHEL PHARMACY LLC

Practice address

205 E Pine St Ste 7
Tulsa, OK 74106-4859

Phone

(918) 505-9650

Fax

(918) 518-7182

NPI assigned

Aug 19, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Aaron Kanwhen

Title

Pharmacy Manager

Phone

(918) 505-9650

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1408406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491264000000",
    "number": "1124427745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 E PINE ST STE 7",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741064859",
            "telephone_number": "918-505-9650",
            "fax_number": "918-518-7182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 E PINE ST STE 7",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741064859",
            "telephone_number": "918-505-9650",
            "fax_number": "918-518-7182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHEL PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-19",
        "last_updated": "2017-04-04",
        "status": "A",
        "authorized_official_last_name": "KANWHEN",
        "authorized_official_first_name": "AARON",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "918-505-9650"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OK",
            "license": "2-6814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200570490A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2147863",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kevin Joe Bethune, MA LPC
• Yodit Teffera Betru, MSW
• Brandon Robert Betsch, MD
• Susan Nicole Bettencourt

• Community/Retail Pharmacy in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Community/Retail Pharmacy in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.