Pawnee Hillcrest Pharmacy Enterprises, LLC
Organization Active NPI Community/Retail Pharmacy · Pawnee, OK
NPI 1003909441 · NPPES record last updated Feb 28, 2019
Key facts
- NPI
- 1003909441
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- PAWNEE HILLCREST PHARMACY ENTERPRISES, LLC
- Practice address
- 539 6TH Street
Pawnee, OK 74058-2542 - Phone
- (918) 762-3666
- Fax
- (918) 762-2288
- NPI assigned
- Sep 30, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Brooke Lynn Tatum, DPH
- Title
- Owner/Pharmacist
- Phone
- (918) 762-3666
Practitioners 3
-
Kelly Earl Douglas, DPH
-
Melissa Kay Dvorak, CPHT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210625001779 | OK | Part B Supplier - Pharmacy | 3678974821 | Practice locations: Pawnee, OK |
National Provider Directory
Locations
539 6th St
Pawnee, OK 74058
Phone (918) 762-3666
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 522742 | OK | |
| Community/Retail Pharmacy | 3336C0003X | Yes | ||
| Compounding Pharmacy | 3336C0004X | |||
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
539 6TH Street
Pawnee, OK 74058-2542
Mailing address
539 6TH Street
Pawnee, OK 74058-2542
Phone (918) 762-3666
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2073056 | Other | PK | |
| 100238450A | Medicaid | OK |
Other names
- Pawnee Hillcrest Pharmacy Inc.
Other providers in Pawnee, OK
- Hunter John Parker
- Pawnee Dental Clinic
- Pawnee Drug Company
- Pawnee Drug, L.L.C.
- Pawnee Health & Wellness Clinic LLC
- Pawnee IHS Pharmacy
- Pawnee Indian Health Center
- Pawnee Municipal Hopsital
- Pawnee Municipal Hospital Authority
- Pawnee Nation Mental Health, LLC
All providers in Pawnee, OK · Community/Retail Pharmacy in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.