NPIMap

Organization Active NPI

Valu-Med Pharmacy, LLC

  • Community/Retail Pharmacy
  • Midwest City, OK
National Provider Identifier
1619986098
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
1-3617 Issued in OK
Legal business name
VALU-MED PHARMACY, LLC
Practice address
1212 S Douglas Blvd
Suite a
Midwest City, OK 73130-5246
Phone
(405) 741-1200
Fax
(405) 741-1224
NPI assigned
Aug 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Dr. Justin Blake Wilson, PHARMDNPI 1861487340
Title
Pharmacist in Charge
Phone
(405) 741-1200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 1-3617 OK Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

1212 S Douglas Blvd
Suite a
Midwest City, OK 73130-5246

Mailing address

1212 S Douglas Blvd
Suite a
Midwest City, OK 73130-5246
Phone (405) 741-1200

Other identifiers 2

IdentifierTypeStateIssuer
3718446OtherOKNCPDP
100242000AMedicaidOK

Other names 1

  • Valu-Med Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061017000157 OK Part B Supplier - Mass Immunization (Roster Biller Only) 9638175599 Practice locations: Midwest City, OK

National Provider Directory

National Provider Directory

Locations

1212 S Douglas Blvd
Ste A
Oklahoma City, OK 73130
Phone (405) 741-1200

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1619986098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 S DOUGLAS BLVD",
            "address_2": "SUITE A",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731305246",
            "telephone_number": "405-741-1200",
            "fax_number": "405-741-1224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 S DOUGLAS BLVD",
            "address_2": "SUITE A",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731305246",
            "telephone_number": "405-741-1200",
            "fax_number": "405-741-1224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALU-MED PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2023-03-07",
        "certification_date": "2021-01-14",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "BLAKE",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "405-741-1200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OK",
            "license": "1-3617",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "3718446",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100242000A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valu-Med Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Valu-Med Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Midwest City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.