Pawnee Hillcrest Pharmacy Enterprises, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 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

Last updated

Feb 28, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Brooke Lynn Tatum, DPHNPI 1235967688

Title

Owner/Pharmacist

Phone

(918) 762-3666

Specialties & licenses 4

Addresses

Other names 1

• Pawnee Hillcrest Pharmacy Inc. Former legal business name

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brooke Tatum

  • Pharmacist
  • Pawnee, OK
  • NPI 1235967688
  NPD Authorized official
• Kelly Earl Douglas, DPH

  • Pharmacist
  • Pawnee, OK
  • NPI 1326143868
  NPD (past)
• Melissa Kay Dvorak, CPHT

  • Pharmacy Technician
  • Pawnee, OK
  • NPI 1306187224
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551312000000",
    "number": "1003909441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "539 6TH STREET",
            "city": "PAWNEE",
            "state": "OK",
            "postal_code": "740582542",
            "telephone_number": "918-762-3666",
            "fax_number": "918-762-2288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "539 6TH STREET",
            "city": "PAWNEE",
            "state": "OK",
            "postal_code": "740582542",
            "telephone_number": "918-762-3666",
            "fax_number": "918-762-2288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAWNEE HILLCREST PHARMACY ENTERPRISES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-30",
        "last_updated": "2019-02-28",
        "status": "A",
        "authorized_official_last_name": "TATUM",
        "authorized_official_first_name": "BROOKE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "918-762-3666",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OK",
            "license": "522742",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pawnee Hillcrest Pharmacy Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Michael Parker
• Pawnee Dental Clinic
• Pawnee Drug Company
• Pawnee Drug, L.L.C. (Pawnee Drug)
• Pawnee Health & Wellness Clinic LLC
• Pawnee IHS Pharmacy
• Pawnee Indian Health Center
• Pawnee Municipal Hopsital (Caring Hands Hospice)
• Pawnee Municipal Hospital Authority (Pawnee Municipal Hospital)
• Pawnee Nation Mental Health, LLC (Pawnee Nation Behavioral Health)

• Community/Retail Pharmacy in Pawnee, OK
• Providers in Pawnee, OK by specialty
• Community/Retail Pharmacy in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.