Okemah Pharmacy LLC
Organization Active NPI Pharmacy · Okemah, OK
NPI 1275167074 · NPPES record last updated Aug 23, 2024
Key facts
- NPI
- 1275167074
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- Legal business name
- OKEMAH PHARMACY LLC
- Practice address
- 106 S Woody Guthrie St
Okemah, OK 74859-4047 - Phone
- (918) 623-2510
- Fax
- (918) 623-0319
- NPI assigned
- Mar 2, 2020
- Organization subpart
- No
Authorized official
- Name
- Ryan Ritter
- Title
- Owner/Manager
- Phone
- (580) 889-0230
Practitioners 1
-
Barrett Kyle Corsini, PHARM.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210122002566 | OK | DME Supplier - Pharmacy | 8527472091 | Practice locations: Okemah, OK |
| O20210202000492 | OK | Part B Supplier - Pharmacy | 8527472091 | Practice locations: Okemah, OK |
National Provider Directory
Locations
106 S Woody Guthrie St
Okemah, OK 74859
Phone (918) 623-2510
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | Yes | ||
| Community/Retail Pharmacy | 3336C0003X | |||
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
106 S Woody Guthrie St
Okemah, OK 74859-4047
Mailing address
744 S Mississippi Ave Ste a
Atoka, OK 74525-3356
Phone (918) 623-2510
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200900380A | Medicaid | OK | |
| 200900380B | Medicaid | OK |
Other names
- Okemah Pharmacy
Other providers in Okemah, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.