Dedmon Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

197806 Issued in OK

Legal business name

DEDMON PHARMACY INC

Doing business as

Sullins Drugs

Practice address

213 W Broadway St
Spiro, OK 74959-2419

Phone

(918) 962-2131

Fax

(918) 962-5750

NPI assigned

Sep 30, 2006

Organization subpart

No

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

Authorized official

Name

Bradley Dedmon, PHARM DNPI 1497881098

Title

President

Phone

(918) 962-2131

Specialties & licenses 5

Addresses

Other identifiers 2

Other names 1

• Sullins Drugs Doing business as

Medicare fee-for-service enrollment

Enrolled in OK2 enrollments

Enrollment records 2

Tax ID family

Dedmon Pharmacy Inc2 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.

• Dedmon Pharmacy Inc

  • Long Term Care Pharmacy
  • Spiro, OK
  • NPI 1326508706
  NPD tax ID

Locations

Practitioners 3

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

• Bradley Wayne Dedmon, P.D.

  • Pharmacist
  • Spiro, OK
  • NPI 1497881098
  NPD Authorized official
• Colton Harper, PHARM.D.

  • Pharmacist
  • Spiro, OK
  • NPI 1679493779
  NPD (past)
• Danielle Loren Dedmon, P.D.

  • Pharmacist
  • Fort Smith, AR
  • NPI 1922147834
  NPD (past)

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

{
    "created_epoch": "1159574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488240000000",
    "number": "1821181264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 220",
            "city": "SPIRO",
            "state": "OK",
            "postal_code": "749590220",
            "telephone_number": "918-962-2131",
            "fax_number": "918-962-5750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 W BROADWAY ST",
            "city": "SPIRO",
            "state": "OK",
            "postal_code": "749592419",
            "telephone_number": "918-962-2131",
            "fax_number": "918-962-5750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEDMON PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-30",
        "last_updated": "2017-02-28",
        "status": "A",
        "authorized_official_last_name": "DEDMON",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "918-962-2131",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OK",
            "license": "197806",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100246960B",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2073256",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sullins Drugs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dayna Marie Cochran
• Orion McClain Cochran
• Amanda Collins, R.N.
• Elizabeth Trudy Davis, APRN-CNP
• Dedmon Pharmacy Inc
• Bradley Wayne Dedmon, P.D.
• Nancy R. Duncan-Larry, PA
• Olie Melane Duncan, PTA
• Arveitta Yvonne Edge, M.D.
• Coty Fisher

• Community/Retail Pharmacy in Spiro, OK
• Providers in Spiro, 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 Feb 28, 2017; 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.