Green Country RX LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

29-6213 Issued in OK

Legal business name

GREEN COUNTRY RX LLC

Doing business as

Bennett's Route 66 Pharmacy

Practice address

700 N Lynn Riggs Blvd
Claremore, OK 74017-5623

Phone

(918) 342-8050

Fax

(918) 342-8099

NPI assigned

Mar 28, 2013

Last updated

Jan 5, 2022By 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

Jared BennettNPI 1669061115

Title

Owner

Phone

(918) 406-6703

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Bennett's Route 66 Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Practitioners 1

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.

• Jared Lee Bennett, RPH

  • Pharmacist
  • Claremore, OK
  • NPI 1669061115
  NPD Authorized official

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

{
    "created_epoch": "1364428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641340800000",
    "number": "1154664191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 N LYNN RIGGS BLVD",
            "city": "CLAREMORE",
            "state": "OK",
            "postal_code": "740175623",
            "telephone_number": "918-342-8050",
            "fax_number": "918-342-8099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 N LYNN RIGGS BLVD",
            "city": "CLAREMORE",
            "state": "OK",
            "postal_code": "740175623",
            "telephone_number": "918-342-8050",
            "fax_number": "918-342-8099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN COUNTRY RX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-28",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-05",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-406-6703"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OK",
            "license": "29-6213",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200486060A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2139596",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bennett's Route 66 Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bennett's Route 66 Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Claremore, OK
• Providers in Claremore, 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 Jan 5, 2022; 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.