Sequoyah County Drug Company PLLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SEQUOYAH COUNTY DRUG COMPANY PLLC

Practice address

1632 S Kerr Blvd
Sallisaw, OK 74955

Phone

(918) 774-0089

Fax

(918) 774-0890

NPI assigned

Oct 9, 2018

Organization subpart

No

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

Authorized official

Name

Mrs. Andrea Joy Self, DPH

Title

President

Phone

(918) 571-8813

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Sequoyah County Drug Company PLLC2 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.

• Sequoyah County Drug Company PLLC

  • Community/Retail Pharmacy
  • Warner, OK
  • NPI 1811553423
  NPD tax ID

Locations

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

{
    "created_epoch": "1539043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642377600000",
    "number": "1174098941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 705",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "749550705",
            "telephone_number": "918-571-8813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1632 S KERR BLVD",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "74955",
            "telephone_number": "918-774-0089",
            "fax_number": "918-774-0890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEQUOYAH COUNTY DRUG COMPANY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-09",
        "last_updated": "2022-01-17",
        "certification_date": "2021-12-08",
        "status": "A",
        "authorized_official_last_name": "SELF",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "JOY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "918-571-8813",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200811470A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sequoyah County City of Sallisaw Hospital Authority
• Sequoyah County City of Sallisaw Hospital Authority
• Sequoyah County City Trust
• Sequoyah County City Trust
• Sequoyah County City Trust Authority
• Sequoyah County-City of Sallisaw Hospital Authority
• Sequoyah County-City of Sallisaw Hospital Authority
• Sequoyah County-City of Sallisaw Hospital Authority
• Sequoyah Manor LLC
• Sequoyah Memorial Hospital

• Community/Retail Pharmacy in Sallisaw, OK
• Providers in Sallisaw, 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 17, 2022; 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.