Tahlequah Drug Company LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

TAHLEQUAH DRUG COMPANY LLC

Doing business as

Tahlequah Drug Company

Practice address

2028 Mahaney Ave
Tahlequah, OK 74464-5783

Phone

(918) 431-0555

Fax

(918) 431-0316

NPI assigned

Aug 18, 2005

Last updated

Apr 8, 2021By 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

Shanon GowerNPI 1194075754

Title

Owner

Phone

(918) 931-9222

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• TAHLEQUAH DRUG COMPANY Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

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

CLIA laboratory certificates

Medicare medical equipment & supply 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.

• Shanon Gower, DPH

  • Pharmacist
  • Tahlequah, OK
  • NPI 1194075754
  NPD Authorized official

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617840000000",
    "number": "1225020811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2028 MAHANEY AVE",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744645783",
            "telephone_number": "918-431-0555",
            "fax_number": "918-431-0316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2028 MAHANEY AVE",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744645783",
            "telephone_number": "918-431-0555",
            "fax_number": "918-431-0316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAHLEQUAH DRUG COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-18",
        "last_updated": "2021-04-08",
        "certification_date": "2021-04-08",
        "status": "A",
        "authorized_official_last_name": "GOWER",
        "authorized_official_first_name": "SHANON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-931-9222"
    },
    "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": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2076569",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200033290A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TAHLEQUAH DRUG COMPANY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "TAHLEQUAH DRUG COMPANY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Aubry Tackett
• Staci Lynn Tackett, PHARM D
• Gary Scott Taggart, PA-C
• Tahlequah City Hospital
• Tahlequah Dental Care PLLC
• Tahlequah Family Medicine Clinic
• Tahlequah Family Vision Clinic, PLLC (Tahlequah Family Vision Clinic)
• Tahlequah Internal Medicine Inc
• Tahlequah Medical Associates
• Tahlequah Medical Group LLC

• Community/Retail Pharmacy in Tahlequah, OK
• Providers in Tahlequah, 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 Apr 8, 2021; 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.