1376728626 NPI number — PHARMACY OPERATIONS INC

Table of content: (NPI 1376728626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376728626 NPI number — PHARMACY OPERATIONS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMACY OPERATIONS INC
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:
MEDICINE SHOPPE
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:
1376728626
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 RIDER TRAIL PLAZA DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
EARTH CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63045-1313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-993-6000
Provider Business Mailing Address Fax Number:
314-872-5558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 BRYAN DR
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
DURANT
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74701-2156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-924-6048
Provider Business Practice Location Address Fax Number:
580-924-0913
Provider Enumeration Date:
01/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FERMAN
Authorized Official First Name:
DENA
Authorized Official Middle Name:
Authorized Official Title or Position:
THIRD PARTY PLAN COORDINATOR
Authorized Official Telephone Number:
314-993-6000

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X , with the licence number: 275289 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3725085 . This is a "NCPDP" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 200132310A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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