Provider Demographics
NPI:1962559583
Name:BETHANY UNITED DRUG CO
Entity type:Organization
Organization Name:BETHANY UNITED DRUG CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHALMER
Authorized Official - Middle Name:HADLEY
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPH
Authorized Official - Phone:405-789-2126
Mailing Address - Street 1:6736 NW 39TH EXPY
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-2647
Mailing Address - Country:US
Mailing Address - Phone:405-789-2126
Mailing Address - Fax:405-603-7496
Practice Address - Street 1:6736 NW 39TH EXPY
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-2647
Practice Address - Country:US
Practice Address - Phone:405-789-2126
Practice Address - Fax:405-603-7496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12421332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3701871OtherNABP #