Provider Demographics
NPI:1598518144
Name:BELL, CALEB VITALIY (DPH)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:VITALIY
Last Name:BELL
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12508 LONGHORN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-6976
Mailing Address - Country:US
Mailing Address - Phone:918-699-9840
Mailing Address - Fax:
Practice Address - Street 1:9122 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4039
Practice Address - Country:US
Practice Address - Phone:918-494-5647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist