Active NPI
Lauren Deatherage, PHARM D
- Pharmacist
- Fort Gibson, OK
National Provider Identifier
1528537230
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 15189
- Practice address
- 1201 S. Lee Street
Fort Gibson, OK 74434-7443 - Phone
- (918) 478-3002
- NPI assigned
- Nov 26, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 15189 | OK | Primary |
Addresses
Primary practice location
1201 S. Lee Street
Fort Gibson, OK 74434-7443
Mailing address
PO Box 967
Fort Gibson, OK 74434-0967
Phone (918) 478-3002
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15189 | OK | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Scotts Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1543190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543190400000",
"number": "1528537230",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 967",
"city": "FORT GIBSON",
"state": "OK",
"postal_code": "744340967",
"telephone_number": "918-478-3002",
"fax_number": "918-478-3017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 S. LEE STREET",
"city": "FORT GIBSON",
"state": "OK",
"postal_code": "744347443",
"telephone_number": "918-478-3002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEATHERAGE",
"first_name": "LAUREN",
"name_prefix": "Dr.",
"credential": "PHARM D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-11-26",
"last_updated": "2018-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "15189",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Gibson, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.