United Pharmacy of Mangum LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

60-4910 Issued in OK

Legal business name

UNITED PHARMACY OF MANGUM LLC

Doing business as

United Pharmacy of Mangum

Practice address

1000 N Louis Tittle Ave
Mangum, OK 73554-2210

Phone

(580) 782-5400

Fax

(580) 782-5404

NPI assigned

Jan 16, 2007

Last updated

May 25, 2016By 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

Bradley Banister, PHRMDNPI 1164501433

Title

Owner and Pharmacist

Phone

(580) 782-5400

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• UNITED PHARMACY OF MANGUM Doing business as

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.

• Bradley Paul Banister, PHARM. D.

  • Pharmacist
  • Mangum, OK
  • NPI 1164501433
  Authorized official Same address or phone

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464134400000",
    "number": "1497806483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N LOUIS TITTLE AVE",
            "city": "MANGUM",
            "state": "OK",
            "postal_code": "735542210",
            "telephone_number": "580-782-5400",
            "fax_number": "580-782-5404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N LOUIS TITTLE AVE",
            "city": "MANGUM",
            "state": "OK",
            "postal_code": "735542210",
            "telephone_number": "580-782-5400",
            "fax_number": "580-782-5404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNITED PHARMACY OF MANGUM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2016-05-25",
        "status": "A",
        "authorized_official_last_name": "BANISTER",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_title_or_position": "OWNER AND PHARMACIST",
        "authorized_official_telephone_number": "580-782-5400",
        "authorized_official_credential": "PHRMD"
    },
    "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": "60-4910",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200046200A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2076977",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UNITED PHARMACY OF MANGUM",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Mangum, OK
• Providers in Mangum, 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 May 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.