NPIMap

Organization Active NPI

Pruett's Food, Inc.

Doing business as Pruett's Food-Pharmacy#7

  • Community/Retail Pharmacy
  • McAlester, OK
National Provider Identifier
1467972539
Registry record updated Nov 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
15-7923 Issued in OK
Legal business name
PRUETT'S FOOD, INC.
Doing business as
Pruett's Food-Pharmacy#7
Practice address
601 E Wyandotte Ave
McAlester, OK 74501-5425
Phone
(918) 423-2980
Fax
(918) 423-4736
NPI assigned
Jun 21, 2017
Last updated
Nov 28, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2021

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

Authorized official

Name
Shannon Pruett
Title
Pharmacy Supervisor
Phone
(580) 236-2056

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 15-7923 OK Primary

Addresses

Primary practice location

601 E Wyandotte Ave
McAlester, OK 74501-5425

Mailing address

210 Main St
Broken Bow, OK 74728-3976
Phone (580) 236-2056

Other identifiers 2

IdentifierTypeStateIssuer
2169356OtherPK
200019990EMedicaidOK

Other names 1

  • PRUETT'S FOOD-PHARMACY#7 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040921001091 OK Part B Supplier - Mass Immunization (Roster Biller Only) 9739157314 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Broken Bow, OK; Valliant, OK; McAlester, OK; Durant, OK; Holdenville, OK; Ada, OK

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Pruetts Food Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

601 E Wyandotte Ave
McAlester, OK 74501
Phone (918) 423-2980

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638057600000",
    "number": "1467972539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 MAIN ST",
            "city": "BROKEN BOW",
            "state": "OK",
            "postal_code": "747283976",
            "telephone_number": "580-236-2056",
            "fax_number": "580-584-6088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E WYANDOTTE AVE",
            "city": "MCALESTER",
            "state": "OK",
            "postal_code": "745015425",
            "telephone_number": "918-423-2980",
            "fax_number": "918-423-4736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRUETT'S FOOD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-21",
        "last_updated": "2021-11-28",
        "certification_date": "2021-11-28",
        "status": "A",
        "authorized_official_last_name": "PRUETT",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "PHARMACY SUPERVISOR",
        "authorized_official_telephone_number": "580-236-2056"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OK",
            "license": "15-7923",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2169356",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200019990E",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRUETT'S FOOD-PHARMACY#7",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in McAlester, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2021; 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.