Blackwell Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

BLACKWELL PHARMACY LLC

Doing business as

Hutton Pharmacy

Practice address

1004 W Doolin Ave
Blackwell, OK 74631-1354

Phone

(580) 363-2137

Fax

(580) 363-5582

NPI assigned

Feb 18, 2016

Last updated

Aug 19, 2024By 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

David L GeorgeNPI 1881171528

Title

Co-Owner/Manager

Phone

(580) 284-7896

Specialties & licenses 4

Addresses

Other identifiers 3

Other names 1

• Hutton Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in OK4 enrollments

Enrollment records 4

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

Blackwell Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Blackwell Pharmacy LLC

  dba Hutton Pharmacy Long-Term Care

  • Long Term Care Pharmacy
  • Blackwell, OK
  • NPI 1407679400
  NPD tax ID

Locations

Practitioners 4

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.

• David L George, PHARMD

  • Pharmacist
  • Edmond, OK
  • NPI 1881171528
  NPD (past) Authorized official
• Justun Kukuk, PHARMD

  • Pharmacist
  • Blackwell, OK
  • NPI 1386236586
  NPD
• Clark Bishop, PHARMD

  • Pharmacist
  • Blackwell, OK
  • NPI 1538639901
  NPD (past)
• Caryen Leemarie Fergeson, RPH

  • Pharmacist
  • Blackwell, OK
  • NPI 1134262603
  NPD (past)

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

{
    "created_epoch": "1455753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1548629579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14101 N EASTERN AVE STE A",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730135860",
            "telephone_number": "580-284-7896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 W DOOLIN AVE",
            "city": "BLACKWELL",
            "state": "OK",
            "postal_code": "746311354",
            "telephone_number": "580-363-2137",
            "fax_number": "580-363-5582"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "119-121 North Main Street",
            "address_purpose": "LOCATION",
            "city": "Blackwell",
            "state": "OK",
            "postal_code": "74631",
            "country_code": "US",
            "telephone_number": "580-363-2137",
            "fax_number": "580-363-5582",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "119 N Main St",
            "address_purpose": "LOCATION",
            "city": "Blackwell",
            "state": "OK",
            "postal_code": "74631",
            "country_code": "US",
            "telephone_number": "580-363-2137",
            "fax_number": "580-363-5582",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLACKWELL PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-18",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "GEORGE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CO-OWNER/MANAGER",
        "authorized_official_telephone_number": "580-284-7896"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200634910 A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200634910A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2158214",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hutton Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hutton Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Blackwell Hospital Trust Authority
• Blackwell Hospital Trust Authority (Blackwell Hospital Physicians Clinic)
• Blackwell Hospital Trust Authority (Blackwell Regional Hospital Home Health Services)
• Blackwell Hospital Trust Authority (Blackwell Hospital Physician's Clinic)
• Blackwell Pharmacy LLC (Hutton Pharmacy Long-Term Care)
• Blackwell Public Schools
• Blackwell Regional Hospital Trust Authority (Blackwell Regional Hospital)
• Blackwell Vision Center Inc
• Jeffrey S Blanton, DC
• Paul A. Briggs, M.D.

• Community/Retail Pharmacy in Blackwell, OK
• Providers in Blackwell, 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 Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.