Laverne Pharmacy Management Inc
Organization Active NPI Community/Retail Pharmacy · Laverne, OK
NPI 1043384431 · NPPES record last updated Feb 12, 2015
Key facts
- NPI
- 1043384431
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 715126 (OK)
- Legal business name
- LAVERNE PHARMACY MANAGEMENT INC
- Practice address
- 102 W Jane Jayroe
Laverne, OK 73848-1250 - Phone
- (580) 921-3373
- Fax
- (580) 921-5469
- NPI assigned
- Nov 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Bryan Bell, RPH
- Title
- Pic
- Phone
- (580) 921-3373
Practitioners 2
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 37D2187549 | Medic Pharmacy & Gifts | Certificate of waiver | Jul 1, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091019000008 | OK | Part B Supplier - Mass Immunization (Roster Biller Only) | 2264579622 | Practice locations: Laverne, OK |
| O20100930090630 | OK | DME Supplier - Pharmacy | 2264579622 | Practice locations: Laverne, OK |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | 715126 | OK | Yes |
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
102 W Jane Jayroe
Laverne, OK 73848-1250
Mailing address
PO Box 1250
Laverne, OK 73848-1250
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100810930B | Medicaid | OK | |
| 2074719 | Other | PK |
Other names
- Medic Pharmacy & Gifts
Other providers in Laverne, OK
- Mary Elizabeth Gates
- Steven Wayne Gates
- Harper County Community Hospital
- Gregory Scott Huenergardt
- Laverne Ambulance Service
- Laverne Pharmacy Management Inc
- Laverne Public Schools
- Timothy Legg
- Shelley K Noble
- Northwest Center for Behavioral Health
All providers in Laverne, 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 12, 2015. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.