Provider Demographics
NPI:1033475587
Name:BEAN, LEMUEL KYLE (DPH)
Entity Type:Individual
Prefix:MR
First Name:LEMUEL
Middle Name:KYLE
Last Name:BEAN
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:MR
Other - First Name:LEMUEL
Other - Middle Name:KYLE
Other - Last Name:BEAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPH
Mailing Address - Street 1:11103 HIGHWAY 76
Mailing Address - Street 2:
Mailing Address - City:HEALDTON
Mailing Address - State:OK
Mailing Address - Zip Code:73438-1723
Mailing Address - Country:US
Mailing Address - Phone:580-229-1141
Mailing Address - Fax:580-229-1136
Practice Address - Street 1:11103 HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:HEALDTON
Practice Address - State:OK
Practice Address - Zip Code:73438-1723
Practice Address - Country:US
Practice Address - Phone:580-229-1141
Practice Address - Fax:580-229-1136
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist