Provider Demographics
NPI:1093716342
Name:BESTYET PHARMACY LLC
Entity Type:Organization
Organization Name:BESTYET PHARMACY LLC
Other - Org Name:BESTYET HEALTHMART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:405-741-1200
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-0098
Mailing Address - Country:US
Mailing Address - Phone:405-454-6261
Mailing Address - Fax:405-454-6261
Practice Address - Street 1:19671 NE 23RD ST
Practice Address - Street 2:
Practice Address - City:HARRAH
Practice Address - State:OK
Practice Address - Zip Code:73045-9305
Practice Address - Country:US
Practice Address - Phone:405-454-6261
Practice Address - Fax:405-454-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
OK1-77543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100239820BMedicaid
OK100239820AMedicaid
2074157OtherPK
OK100239820AMedicaid
2074157OtherPK
OK900522407Medicare PIN