Provider Demographics
NPI:1114937018
Name:BELL, GARY WALTER JR (RPH)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:WALTER
Last Name:BELL
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1747 MELROSE DR
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-7025
Mailing Address - Country:US
Mailing Address - Phone:918-333-5960
Mailing Address - Fax:
Practice Address - Street 1:1117 SE FRANK PHILLIPS BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-4319
Practice Address - Country:US
Practice Address - Phone:918-336-2140
Practice Address - Fax:918-336-2145
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist