NPIMap

Organization Active NPI

Jack Justice

  • Community/Retail Pharmacy
  • Maysville, OK
National Provider Identifier
1881769487
Registry record updated Feb 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
22-4098 Issued in OK
Legal business name
JACK JUSTICE
Practice address
500 Williams
Maysville, OK 73057-3679
Phone
(405) 867-4427
Fax
(405) 867-5267
NPI assigned
Nov 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2021

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 22-4098 OK Primary

Addresses

Primary practice location

500 Williams
Maysville, OK 73057-3679

Mailing address

PO Box 217
Maysville, OK 73057-0217
Phone (405) 867-4427

Other identifiers 1

IdentifierTypeStateIssuer
100235750DMedicaidOK

Other names 1

  • Jack's RX Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200602002904 OK DME Supplier - Pharmacy 9739181348 Practice locations: Maysville, OK
O20200810000732 OK Part B Supplier - Pharmacy 9739181348 1 other NPI on this enrollment
Practice locations: Maysville, OK; Pauls Valley, OK

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Jack'S RX500 Williams, Maysville, OK 73057-3679(405) 867-4428 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Ostomy Supplies|Tracheotomy Supplies|Urological Supplies|Enteral Nutrients|Surgical Dressings|Lymphedema Compression Treatment Items Accepts assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Reavis Drug2 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.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612483200000",
    "number": "1881769487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 217",
            "city": "MAYSVILLE",
            "state": "OK",
            "postal_code": "730570217",
            "telephone_number": "405-867-4427",
            "fax_number": "405-867-5267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 WILLIAMS",
            "city": "MAYSVILLE",
            "state": "OK",
            "postal_code": "730573679",
            "telephone_number": "405-867-4427",
            "fax_number": "405-867-5267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK JUSTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-05",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OK",
            "license": "22-4098",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100235750D",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jack's RX",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maysville, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.