Pruett'S Food, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PRUETT'S FOOD, INC.

Doing business as

Uptown Pharmacy (Pruett's OKC)

Practice address

9515 N May Ave
The Village, OK 73120

Phone

(405) 286-9080

Fax

(405) 286-9832

NPI assigned

Jan 31, 2021

Organization subpart

Yes

Parent organization

PRUETT'S FOOD, INC.As reported in NPPES

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

Authorized official

Name

Shannon Jewelanna Pruett

Title

Pharmacy Director

Phone

(580) 236-2056

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Uptown Pharmacy (Pruett's OKC) Doing business as

Part of

Pruetts Food Inc

Locations

Practitioners 1

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

• Lan Ngoc Helmig, PHARM.D.

  • Pharmacist
  • The Village, OK
  • NPI 1598140915
  NPD

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

{
    "created_epoch": "1612051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618185600000",
    "number": "1629669874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 MAIN STREET",
            "city": "BROKEN BOW",
            "state": "OK",
            "postal_code": "74728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9515 N MAY AVE",
            "city": "THE VILLAGE",
            "state": "OK",
            "postal_code": "73120",
            "telephone_number": "405-286-9080",
            "fax_number": "405-286-9832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRUETT'S FOOD, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRUETT'S FOOD, INC.",
        "enumeration_date": "2021-01-31",
        "last_updated": "2021-04-12",
        "certification_date": "2021-04-12",
        "status": "A",
        "authorized_official_last_name": "PRUETT",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "JEWELANNA",
        "authorized_official_title_or_position": "PHARMACY DIRECTOR",
        "authorized_official_telephone_number": "580-236-2056"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200019990J",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Uptown Pharmacy (Pruett's OKC)",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Uptown Pharmacy (Pruett's OKC)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sara Nicole Kling, BHRS
• Daniel Leiker, CRNA
• Tango L. McCauley Sr.
• Carter Mark Methvin
• Leroy Ngo
• Nicole Ray
• Renew Physical Therapy, LLC
• Bradley Allen Sablatura, PHARMD
• Kerry Leon Seay
• Allison Stephens, PHARM D

• Community/Retail Pharmacy in The Village, OK
• Providers in The Village, 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 Apr 12, 2021; 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.