Matt'S Country Boy Pharmacy LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

1-6052 Issued in OK

Legal business name

MATT'S COUNTRY BOY PHARMACY LLC

Doing business as

country boy pharmacy

Practice address

14890 SE 29TH St Ste 108
Choctaw, OK 73020-3516

Phone

(405) 390-3205

Fax

(405) 390-2516

NPI assigned

Oct 5, 2012

Organization subpart

No

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

Authorized official

Name

Matt Evans

Title

Pharmacist/Owner

Phone

(405) 390-3205

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• country boy pharmacy Doing business as

Locations

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

{
    "created_epoch": "1349395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472083200000",
    "number": "1164774709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14890 SE 29TH ST STE 108",
            "city": "CHOCTAW",
            "state": "OK",
            "postal_code": "730203516",
            "telephone_number": "405-390-3205",
            "fax_number": "405-390-2516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14890 SE 29TH ST STE 108",
            "city": "CHOCTAW",
            "state": "OK",
            "postal_code": "730203516",
            "telephone_number": "405-390-3205",
            "fax_number": "405-390-2516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATT'S COUNTRY BOY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-05",
        "last_updated": "2016-08-25",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "PHARMACIST/OWNER",
        "authorized_official_telephone_number": "405-390-3205"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "OK",
            "license": "1-6052",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2137264",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200464490A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "country boy pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mark'S Prescription Shop Inc
• Annika Leigh Martin
• Ashley Ann Martin
• Kathleen Rose Martin, DPH
• Mykayla Nicole Matlock
• Judson May, DDS
• Tessa S McConnell, APRN
• Brenda Jo McCracken
• Jimmy Scott McWhirter, LPC
• Martha Meurer, SLP

• Pharmacy in Choctaw, OK
• Providers in Choctaw, OK by specialty
• Pharmacy in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.