Thackerville Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

72-5917 Issued in OK

Legal business name

THACKERVILLE PHARMACY

Doing business as

Thackerville Pharmacy

Practice address

11530 Ridge Rd Ste 1
Thackerville, OK 73459-9623

Phone

(580) 276-5161

Fax

(580) 276-9063

NPI assigned

Jan 18, 2011

Organization subpart

No

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

Authorized official

Name

Susan South

Title

Manager

Phone

(580) 276-5161

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Thackerville Pharmacy Doing business as

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

{
    "created_epoch": "1295308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488758400000",
    "number": "1669777058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11530 RIDGE RD",
            "address_2": "SUITE 1",
            "city": "THACKERVILLE",
            "state": "OK",
            "postal_code": "734599622",
            "telephone_number": "580-276-5161",
            "fax_number": "580-276-9063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11530 RIDGE RD STE 1",
            "city": "THACKERVILLE",
            "state": "OK",
            "postal_code": "734599623",
            "telephone_number": "580-276-5161",
            "fax_number": "580-276-9063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THACKERVILLE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-18",
        "last_updated": "2017-03-06",
        "status": "A",
        "authorized_official_last_name": "SOUTH",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "580-276-5161"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OK",
            "license": "72-5917",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200339440A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "580121",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2129291",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Thackerville Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rainey Jo Hitt, RN
• Casey Jon Hucks, LPC
• Cynthia Pickens
• Red River Valley Health PLLC
• Thackerville Medical Clinic
• Thackerville Public Schools

• Community/Retail Pharmacy in Thackerville, OK
• Providers in Thackerville, 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 6, 2017; 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.