Mark'S Prescription Shop Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

1-4081 Issued in OK

Legal business name

MARK'S PRESCRIPTION SHOP INC

Doing business as

Country Boy Pharmacy

Practice address

1530 S Choctaw Rd Ste a
Choctaw, OK 73020-7096

Phone

(405) 390-3205

Fax

(405) 390-3206

NPI assigned

Apr 19, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Matt Evans, D.PH.

Title

Pharmacist

Phone

(405) 390-3205

Specialties & licenses 1

Addresses

Other names 1

• Country Boy Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323388800000",
    "number": "1609093681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 S CHOCTAW RD STE A",
            "city": "CHOCTAW",
            "state": "OK",
            "postal_code": "730207096",
            "telephone_number": "405-390-3205",
            "fax_number": "405-390-3206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 S CHOCTAW RD STE A",
            "city": "CHOCTAW",
            "state": "OK",
            "postal_code": "730207096",
            "telephone_number": "405-390-3205",
            "fax_number": "405-390-3206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK'S PRESCRIPTION SHOP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2011-12-09",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "405-390-3205",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.PH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OK",
            "license": "1-4081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Boy Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Deesha Brooke Lornes, FNP-BC
• Jill Mechelle Loveless, PHARM.D.
• Emily Marie Ludtke, RBT
• Nhu Thuy Luong, P.A.-C
• Gallerie Lynch, BA
• Annika Leigh Martin
• Ashley Ann Martin
• Kathleen Rose Martin, DPH
• Mykayla Nicole Matlock
• Matt'S Country Boy Pharmacy LLC

• Community/Retail Pharmacy in Choctaw, OK
• Providers in Choctaw, 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 Dec 9, 2011; 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.