Idabel Express Pharmacy, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

IDABEL EXPRESS PHARMACY, LLC

Practice address

810 SE Washington St
Idabel, OK 74745-3332

Phone

(580) 245-6169

Fax

(580) 208-2372

NPI assigned

Sep 23, 2019

Organization subpart

No

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

Authorized official

Name

Susan Ann Ritter

Title

Owner

Phone

(580) 889-1283

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Idabel Express Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in OK2 enrollments

Enrollment records 2

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

Locations

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

{
    "created_epoch": "1569196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580774400000",
    "number": "1962053843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 870",
            "city": "ATOKA",
            "state": "OK",
            "postal_code": "745250870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 SE WASHINGTON ST",
            "city": "IDABEL",
            "state": "OK",
            "postal_code": "747453332",
            "telephone_number": "580-245-6169",
            "fax_number": "580-208-2372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDABEL EXPRESS PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-23",
        "last_updated": "2020-02-04",
        "certification_date": "2020-02-04",
        "status": "A",
        "authorized_official_last_name": "RITTER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "580-889-1283"
    },
    "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": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200875410A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Idabel Express Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Idabel Express Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Idabel, OK
• Community/Retail Pharmacy in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2020; 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.