Scotts Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

4-6086 Issued in OK

Legal business name

SCOTTS PHARMACY LLC

Practice address

1201 S Lee St
Fort Gibson, OK 74434

Phone

(918) 478-3002

Fax

(918) 478-3017

NPI assigned

Sep 6, 2006

Organization subpart

No

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

Authorized official

Name

Justin Blake Wilson

Title

Owner

Phone

(405) 741-1200

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Valu-Med Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Practitioners 2

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

• Lauren Deatherage, PHARM D

  • Pharmacist
  • Fort Gibson, OK
  • NPI 1528537230
  NPD (past)
• Justin Matthew Wedman, PHARM. D.

  • Pharmacist
  • Fort Gibson, OK
  • NPI 1356643936
  NPD (past)

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636502400000",
    "number": "1891898912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 967",
            "city": "FORT GIBSON",
            "state": "OK",
            "postal_code": "744340967",
            "telephone_number": "918-478-3002",
            "fax_number": "918-478-3017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 S LEE ST",
            "city": "FORT GIBSON",
            "state": "OK",
            "postal_code": "74434",
            "telephone_number": "918-478-3002",
            "fax_number": "918-478-3017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTTS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-06",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "BLAKE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-741-1200"
    },
    "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": "4-6086",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100238350A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2124412",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valu-Med Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Valu-Med Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Thomas W Potter, LCSW
• James Allen Ratterree
• Haley Lynn Ryan
• Jayton Micah Salmans, OD
• Taylor Raylynn Scott, PTA
• James Mark Seabolt
• Taldg PLLC
• Mindy E Taylor-Culver, LPC
• Heather Raye Taylor
• Wanda Ann Teague, M.S., ED., CCC-SLP

• Community/Retail Pharmacy in Fort Gibson, OK
• Providers in Fort Gibson, 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 Nov 10, 2021; 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.