Collinsville Family Pharmacy LC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

26388 Issued in OK

Legal business name

COLLINSVILLE FAMILY PHARMACY LC

Doing business as

COLLINSVILLE FAMILY PHARMACY

Practice address

1205 W Main St Ste a
Collinsville, OK 74021-3114

Phone

(918) 371-2547

Fax

(918) 371-0268

NPI assigned

Jun 21, 2006

Organization subpart

No

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

Authorized official

Name

Colton B TurnbullNPI 1508391053

Title

Pharmacist and Owner

Phone

(918) 371-2547

Specialties & licenses 4

Addresses

Other identifiers 3

Other names 1

• COLLINSVILLE FAMILY PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Collinsville Family Pharmacy LC

  • Long Term Care Pharmacy
  • Collinsville, OK
  • NPI 1396580676
  NPPES parent name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Colton Turnbull, DPH

  • Pharmacist
  • Collinsville, OK
  • NPI 1508391053
  NPD Authorized official
• Sherri Laverne Clark, DPH

  • Pharmacist
  • Collinsville, OK
  • NPI 1114085214
  NPD

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594166400000",
    "number": "1336185222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 W MAIN ST STE A",
            "city": "COLLINSVILLE",
            "state": "OK",
            "postal_code": "740213114",
            "telephone_number": "918-371-2547",
            "fax_number": "918-371-0268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 W MAIN ST STE A",
            "city": "COLLINSVILLE",
            "state": "OK",
            "postal_code": "740213114",
            "telephone_number": "918-371-2547",
            "fax_number": "918-371-0268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLINSVILLE FAMILY PHARMACY LC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2020-07-08",
        "certification_date": "2020-07-08",
        "status": "A",
        "authorized_official_last_name": "TURNBULL",
        "authorized_official_first_name": "COLTON",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PHARMACIST AND OWNER",
        "authorized_official_telephone_number": "918-371-2547"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OK",
            "license": "26388",
            "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": "2081529",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100807920B",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100807920A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COLLINSVILLE FAMILY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "COLLINSVILLE FAMILY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• City of Sapulpa
• Sherri Laverne Clark, DPH
• Emily Cline
• Kelly Faye Coffin, RN
• Collinsville Family Clinic, Inc.
• Collinsville Family Pharmacy LC
• Collinsville Primary Eyecare
• Collinsville Public Schools
• Collinsville Rural Fire Protection District
• Cordero Counseling, PLLC

• Community/Retail Pharmacy in Collinsville, OK
• Providers in Collinsville, 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 Jul 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.