Veritas Properties LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

675089 Issued in OK

Legal business name

VERITAS PROPERTIES LLC

Doing business as

Main Street Drug

Practice address

225 W Main St
Wilburton, OK 74578-4045

Phone

(918) 465-9300

Fax

(918) 465-9303

NPI assigned

Jul 1, 2006

Last updated

Mar 5, 2021By 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

Darren TidwellNPI 1346478765

Title

Owner

Phone

(918) 465-9300

Specialties & licenses 5

Addresses

Other identifiers 3

Other names 1

• MAIN STREET DRUG Doing business as

Medicare fee-for-service enrollment

Enrolled in OK3 enrollments

Enrollment records 3

Tax ID family

Veritas Properties 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.

• Veritas Properties LLC

  dba Main Street Drug

  • Long Term Care Pharmacy
  • Wilburton, OK
  • NPI 1093271769
  NPD tax ID

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.

• Darren Tidwell, DPH

  • Pharmacist
  • Wilburton, OK
  • NPI 1346478765
  Authorized official Same address or phone

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614902400000",
    "number": "1629007893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 W MAIN ST",
            "city": "WILBURTON",
            "state": "OK",
            "postal_code": "745784045",
            "telephone_number": "918-465-9300",
            "fax_number": "918-465-9303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 W MAIN ST",
            "city": "WILBURTON",
            "state": "OK",
            "postal_code": "745784045",
            "telephone_number": "918-465-9300",
            "fax_number": "918-465-9303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VERITAS PROPERTIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2021-03-05",
        "certification_date": "2021-03-05",
        "status": "A",
        "authorized_official_last_name": "TIDWELL",
        "authorized_official_first_name": "DARREN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-465-9300"
    },
    "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": "OK",
            "license": "675089",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty 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": "200081170B",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2076464",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200081170A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAIN STREET DRUG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Crystal Renee Toland
• Misty D Tom
• Ricardo Mariano Valbuena, MD
• Robert Eugene Vandiver II, P.A.
• Veritas Properties LLC (Main Street Drug)
• Caleb Seth Vinson, MS LPC
• Zackary Vinson
• Talisa Walker
• Danni R. Webb, M.ED
• Nicholas Weston, ARNP

• Community/Retail Pharmacy in Wilburton, OK
• Providers in Wilburton, 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 Mar 5, 2021; 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.