SOVEREIGN PHARMACY SOLUTIONS LLC (SOVEREIGN PHARMACY SOLUTIONS & FINE GIFTS) - NPI NUMBER 1710249628

Summary

Provider Name: SOVEREIGN PHARMACY SOLUTIONS LLC (SOVEREIGN PHARMACY SOLUTIONS & FINE GIFTS)

NPI Number: 1710249628

Clasification: Pharmacy (333600000X)

Address:
1007 N COUNTRY CLUB RD
ADA, OK
ZIP 74820

Phone Number: (580) 421-8775



Detailed Information

SOVEREIGN PHARMACY SOLUTIONS LLC is a pharmacy in Ada, OK. The provider is a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. The assigned NPI number for this provider is 1710249628 and is registered as an organization entity type.
The provider Is Doing Business As Sovereign Pharmacy Solutions & Fine Gifts.

The provider's business address is:

1007 N COUNTRY CLUB RD
ADA, OK
ZIP 74820-847
Phone: (580) 421-8775
Fax: (580) 421-8789

The provider's authorized official is Lisa Fillmore Fillmore .
The authorized official title is Pharmacist In Charge and has the following contact phone number (580) 421-8733.

The enumeration date for this NPI number is 6/15/2012 and was last updated on 1/21/2014.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 333600000X Pharmacy No
2 3336C0003X Pharmacy Community/Retail Pharmacy 23-5966 OK Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 200436850A MEDICAID OK
2 2135608 OTHER PK

NPI Record

No. Field Name Field Value
1 NPI 1710249628
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name SOVEREIGN PHARMACY SOLUTIONS LLC
5 Provider Other Organization Name SOVEREIGN PHARMACY SOLUTIONS & FINE GIFTS
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 1007 N COUNTRY CLUB RD
8 Provider Business Practice Location Address City Name ADA
9 Provider Business Practice Location Address State Name OK
10 Provider Business Practice Location Address Postal Code 748202847
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 5804218775
13 Provider Business Practice Location Address Fax Number 5804218789
14 Provider Enumeration Date 6/15/2012
15 Last Update Date 1/21/2014
16 Authorized Official Last Name FILLMORE
17 Authorized Official First Name LISA FILLMORE
18 Authorized Official Title or Position PHARMACIST IN CHARGE
19 Authorized Official Telephone Number 5804218733
20 Healthcare Provider Taxonomy Code 1 333600000X
21 Healthcare Provider Primary Taxonomy Switch 1 N
22 Healthcare Provider Taxonomy Code 2 3336C0003X
23 Provider License Number 2 23-5966
24 Provider License Number State Code 2 OK
25 Healthcare Provider Primary Taxonomy Switch 2 Y
26 Other Provider Identifier 1 200436850A
27 Other Provider Identifier Type Code 1 05
28 Other Provider Identifier State 1 OK
29 Other Provider Identifier 2 2135608
30 Other Provider Identifier Type Code 2 01
31 Other Provider Identifier Issuer 2 PK
32 Is Organization Subpart N

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This page was last updated on: 10/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.