Joe Brent Fortson
Individual provider Active NPI Pharmacist · Hugo, OK
NPI 1285387662 · NPPES record last updated Jan 27, 2022
Key facts
- NPI
- 1285387662
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 11961 (OK)
- Practice address
- 1911 E Jackson St
Hugo, OK 74743-4249 - Phone
- (580) 326-7541
- NPI assigned
- Jan 27, 2022
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East, LP | Past |
Accepting new patients | |
| Wal-Mart Stores East LP | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 11961 | OK | Yes |
Addresses
Primary practice location
1911 E Jackson St
Hugo, OK 74743-4249
Mailing address
PO Box 781
Hugo, OK 74743-0781
Phone (580) 579-8497
Other providers in Hugo, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.