NPIMap

Organization Active NPI

Creative Care Pharmacy, LLC

  • Community/Retail Pharmacy
  • Edmond, OK
National Provider Identifier
1639518038
Registry record updated Jul 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
CREATIVE CARE PHARMACY, LLC
Practice address
14101 N Eastern Ave
Suite a
Edmond, OK 73013-5859
Phone
(405) 562-1800
Fax
(405) 562-1880
NPI assigned
Jun 19, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2020

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

Authorized official

Name
Dr. David George, PHARMD
Title
Co-Owner
Phone
(405) 562-1800

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary
Compounding Pharmacy 3336C0004X
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

14101 N Eastern Ave
Suite a
Edmond, OK 73013-5859

Mailing address

14101 N Eastern Ave
Suite a
Edmond, OK 73013-5859
Phone (405) 562-1800

Other identifiers 1

IdentifierTypeStateIssuer
200494830AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20131024001803 OK Part B Supplier - Mass Immunization (Roster Biller Only) 1254566409 Practice locations: Oklahoma City, OK
O20150113001604 OK DME Supplier - Pharmacy 1254566409 Practice locations: Edmond, OK
O20211220000712 OK Part B Supplier - Independent Clinical Laboratory 1254566409 Practice locations: Edmond, OK

National Provider Directory

National Provider Directory
Tax ID family
Creative Care Pharmacy 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.

NPI Registry JSON

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

{
    "created_epoch": "1371600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593993600000",
    "number": "1639518038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14101 N EASTERN AVE",
            "address_2": "SUITE A",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730135859",
            "telephone_number": "405-562-1800",
            "fax_number": "405-562-1880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14101 N EASTERN AVE",
            "address_2": "SUITE A",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730135859",
            "telephone_number": "405-562-1800",
            "fax_number": "405-562-1880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE CARE PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-19",
        "last_updated": "2020-07-06",
        "certification_date": "2020-07-06",
        "status": "A",
        "authorized_official_last_name": "GEORGE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "405-562-1800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200494830A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2020; 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.