Jack Justice

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

223755 Issued in OK

Legal business name

JACK JUSTICE

Practice address

110 Burr Ave
Pauls Valley, OK 73075-3848

Phone

(405) 238-7391

Fax

(405) 238-1162

NPI assigned

Jan 2, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Jack Lee Justice, DPH

Title

Owner Pharmacist

Phone

(405) 238-7391

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Reavis Rexall Drug Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Jack Justice

  • Community/Retail Pharmacy
  • Maysville, OK
  • NPI 1881769487

  9739181348

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Tax ID family

Reavis Drug2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Jack Justice

  • Community/Retail Pharmacy
  • Maysville, OK
  • NPI 1881769487
  NPD tax ID

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1013074111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 BURR AVE",
            "city": "PAULS VALLEY",
            "state": "OK",
            "postal_code": "730753848",
            "telephone_number": "405-238-7391",
            "fax_number": "405-238-1162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BURR AVE",
            "city": "PAULS VALLEY",
            "state": "OK",
            "postal_code": "730753848",
            "telephone_number": "405-238-7391",
            "fax_number": "405-238-1162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK JUSTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "JUSTICE",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER PHARMACIST",
        "authorized_official_telephone_number": "405-238-7391",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "OK",
            "license": "223755",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "OK",
            "license": "223755",
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "OK",
            "license": "223755",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100235750B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Reavis Rexall Drug",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary T. Hope, PHD, LPC
• Zac Howe
• Shelby Dawn Howland, LPC
• Ann Hull, DPH
• Hali Humphrey
• Jack Justice
• Letitia Lynn Jackson, APRN-CNP
• Scotty Jackson, FNP-BC
• Cynthia A. Jacobson, DPH.
• James R Ward, Family Dentistry, PC

• Oxygen Equipment & Supplies (DME) in Pauls Valley, OK
• Providers in Pauls Valley, OK by specialty
• Oxygen Equipment & Supplies (DME) in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.