Pharmology Tishmingo Acquisition LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PHARMOLOGY TISHMINGO ACQUISITION LLC

Practice address

140 E Main St
Tishomingo, OK 73460-2838

Phone

(580) 371-2355

Fax

(580) 371-0000

NPI assigned

Jun 5, 2020

Organization subpart

No

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

Authorized official

Name

Susan Ritter, DPH

Title

Owner

Phone

(580) 889-0230

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Tishomingo Express Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in OK2 enrollments

Enrollment records 2

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

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1591315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607990400000",
    "number": "1124642178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "744 S MISSISSIPPI AVE STE A",
            "city": "ATOKA",
            "state": "OK",
            "postal_code": "745253356",
            "telephone_number": "580-371-2355",
            "fax_number": "580-371-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 E MAIN ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734602838",
            "telephone_number": "580-371-2355",
            "fax_number": "580-371-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARMOLOGY TISHMINGO ACQUISITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-05",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A",
        "authorized_official_last_name": "RITTER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "580-889-0230",
        "authorized_official_credential": "DPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200909800",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tishomingo Express Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Tishomingo, OK
• Providers in Tishomingo, 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 Dec 15, 2020; 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.