Provider Demographics
NPI:1669505616
Name:BESTYET HEALTHMART PHARMACY
Entity Type:Organization
Organization Name:BESTYET HEALTHMART PHARMACY
Other - Org Name:
Other - Org Type:
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:405-454-6262
Practice Address - Street 1:19671 N E 23RD
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:2007-03-13
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-3041332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100239820BMedicaid
OK1093716342OtherPHARMACY NPI
OK1-3041OtherPHARMACY LISCENSE
OK100239820AMedicaid