E D Allens Pharmacy of Broken Bow Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

255237 Issued in OK

Legal business name

E D ALLENS PHARMACY OF BROKEN BOW INC

Doing business as

Eddie Allens Pharmacy

Practice address

619 S Park Dr
Broken Bow, OK 74728-5331

Phone

(580) 584-5841

Fax

(580) 584-5845

NPI assigned

Dec 15, 2006

Last updated

Jun 7, 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

Eddie AllenNPI 1073675732

Title

Manager

Phone

(580) 584-5841

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• EDDIE ALLENS PHARMACY 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.

• Eddie D Allen, DPH

  • Pharmacist
  • Broken Bow, OK
  • NPI 1073675732
  Authorized official Same address or phone

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465257600000",
    "number": "1609938349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "619 S PARK DR",
            "city": "BROKEN BOW",
            "state": "OK",
            "postal_code": "747285331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 S PARK DR",
            "city": "BROKEN BOW",
            "state": "OK",
            "postal_code": "747285331",
            "telephone_number": "580-584-5841",
            "fax_number": "580-584-5845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "E D ALLENS PHARMACY OF BROKEN BOW INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2016-06-07",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "EDDIE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "580-584-5841"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OK",
            "license": "255237",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100237740A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2073473",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EDDIE ALLENS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Choctaw Nation of Oklahoma (Choctaw Nation Health Clinic - Broken Bow)
• Choctaw Nation of Oklahoma (Choctaw Nation Health Clinic-Broken Bow)
• Complete Care Medical, Inc.
• Steven M Deaton, DDS
• Rhonda Jo Deramus, MSN, APRN, FNP-C
• Kenneth G Ericksen, D.C.
• Faith L. Phillips, PH.D., PLLC
• Family Medical Clinic
• Tabitha Nicole Ferguson
• Alora S Fulgium

• Community/Retail Pharmacy in Broken Bow, OK
• Providers in Broken Bow, 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 Jun 7, 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.