1285751651 NPI number — SCHEFFE RX

Table of content: (NPI 1285751651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285751651 NPI number — SCHEFFE RX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHEFFE RX
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SCHEFFE PRESCRIPTION SHOP PARKVIEW
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285751651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1925 W OWEN K GARRIOTT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENID
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73703-5528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-233-2128
Provider Business Mailing Address Fax Number:
580-548-8463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 S 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENID
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73701-5825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-233-2128
Provider Business Practice Location Address Fax Number:
580-548-8463
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PRYOR
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
580-233-2152

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 55253 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200122690B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2072783 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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