Jack Justice

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

22-3755 Issued in OK

Legal business name

JACK JUSTICE

Practice address

110 A Burr Ave
Pauls Valley, OK 73075-1220

Phone

(405) 238-7391

Fax

(405) 238-7357

NPI assigned

Jul 1, 2005

Organization subpart

No

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

Authorized official

Name

Julie Justice

Title

Authorized Official

Phone

(405) 447-3911

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Reavis Super Drug Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Jack Justice

  • Community/Retail Pharmacy
  • Maysville, OK
  • NPI 1881769487

  O20200810000732

  Same enrollment

Locations

Practitioners 1

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

• Patty Janelle Potts, DPH

  • Pharmacist
  • Maysville, OK
  • NPI 1164417739
  NPD (past)

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

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730073600000",
    "number": "1699772806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1220",
            "city": "PAULS VALLEY",
            "state": "OK",
            "postal_code": "730752020",
            "telephone_number": "405-238-7391",
            "fax_number": "405-238-1162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 A BURR AVE",
            "city": "PAULS VALLEY",
            "state": "OK",
            "postal_code": "730751220",
            "telephone_number": "405-238-7391",
            "fax_number": "405-238-7357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK JUSTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-01",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A",
        "authorized_official_last_name": "JUSTICE",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "405-447-3911"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OK",
            "license": "22-3755",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2073053",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100235750A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Reavis Super Drug",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Zac Howe
• Shelby Dawn Howland, LPC
• Ann Hull, DPH
• Hali Humphrey
• Jack Justice
• Letitia Lynn Jackson, APRN-CNP
• Scotty Jackson, FNP-BC
• Cynthia A. Jacobson, DPH.
• James R Ward, Family Dentistry, PC
• Jamie L. Means, DDS, PLLC

• Community/Retail Pharmacy in Pauls Valley, OK
• Providers in Pauls Valley, 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 Oct 28, 2024; 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.