NPIMap

Organization Active NPI

Wewoka IHS Pharmacy

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Wewoka, OK
National Provider Identifier
1568512374
Registry record updated Oct 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
License
24-3295 Issued in OK
Legal business name
WEWOKA IHS PHARMACY
Doing business as
WEWOKA IHS PHARMACY
Practice address
Intersection of Hwy 56 and 270
Wewoka, OK 74884
Phone
(405) 257-6281
Fax
(405) 257-2696
NPI assigned
Jan 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2016

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

Authorized official

Name
Tracie Patten, PHARMD
Title
Area Pharmacy Consultant
Phone
(405) 951-6035

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X 24-3295 OK Primary

Addresses

Primary practice location

Intersection of Hwy 56 and 270
Wewoka, OK 74884

Mailing address

PO Box 676729
Dallas, TX 75267-6729

Other identifiers 3

IdentifierTypeStateIssuer
100231960JMedicaidOK
1100231960JMedicaidOK
2076399OtherPK

Other names 1

  • WEWOKA IHS PHARMACY Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476835200000",
    "number": "1568512374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 676729",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752676729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "INTERSECTION OF HWY 56 AND 270",
            "city": "WEWOKA",
            "state": "OK",
            "postal_code": "74884",
            "telephone_number": "405-257-6281",
            "fax_number": "405-257-2696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEWOKA IHS PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-12",
        "last_updated": "2016-10-19",
        "status": "A",
        "authorized_official_last_name": "PATTEN",
        "authorized_official_first_name": "TRACIE",
        "authorized_official_title_or_position": "AREA PHARMACY CONSULTANT",
        "authorized_official_telephone_number": "405-951-6035",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "OK",
            "license": "24-3295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100231960J",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1100231960J",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2076399",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WEWOKA IHS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wewoka, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 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.