Pruett Foods Pharmacy

LBN: Pruetts Food Inc
Pruett Foods Pharmacy is an health care organization with primary practice located at 201 S Park Dr , Broken Bow OK 74728-4737. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Pruetts Food Inc can be contacted via phone (580) 584-6085, or through Pruett, Shannon Jewelanna via phone (580) 584-6089.

Contact Information

Primary practice address
201 S Park Dr Broken Bow OK 74728-4737
Phone: (580) 584-6085
Fax: (580) 584-6088
Website:
Map and Directions
Authorized official contact:
Name: Pruett, Shannon Jewelanna
Phone: (580) 584-6089

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X 25-6949 Oklahoma

Profile Details

NPI number 1689673832
LBN Legal business name Pruetts Food Inc
DBA Doing business as Pruett Foods Pharmacy
Authorized official Pruett, Shannon Jewelanna
Entity Organization
Organization subpart 1 No
Enumeration date Jul 19th, 2005
Last updated Jan 31st, 2021 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689673832 NPPES
Oklahoma MEDICAID 200019990A
Oklahoma Other 2076565

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