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

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 Field Definition 1
1 NPI 1710249628 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name SOVEREIGN PHARMACY SOLUTIONS LLC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name SOVEREIGN PHARMACY SOLUTIONS & FINE GIFTS Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 1007 N COUNTRY CLUB RD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Business Practice Location Address City Name ADA The city name in the location address of the provider being identified.
9 Provider Business Practice Location Address State Name OK The State code in the location of the provider being identified.
10 Provider Business Practice Location Address Postal Code 748202847 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
11 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
12 Provider Business Practice Location Address Telephone Number 5804218775 The telephone number associated with the location address of the provider being identified.
13 Provider Business Practice Location Address Fax Number 5804218789 The fax number associated with the location address of the provider being identified.
14 Provider Enumeration Date 6/15/2012 The date the provider was assigned a unique identifier (assigned an NPI).
15 Last Update Date 1/21/2014 The date that a record was last updated or changed.
16 Authorized Official Last Name FILLMORE The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
17 Authorized Official First Name LISA FILLMORE The first name of the authorized official.
18 Authorized Official Title or Position PHARMACIST IN CHARGE The title or position of the authorized official.
19 Authorized Official Telephone Number 5804218733 The 10-position telephone number of the authorized official.
20 Healthcare Provider Taxonomy Code 1 333600000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
21 Healthcare Provider Primary Taxonomy Switch 1 N
22 Healthcare Provider Taxonomy Code 2 3336C0003X
23 Provider License Number 2 23-5966 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
24 Provider License Number State Code 2 OK The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
25 Healthcare Provider Primary Taxonomy Switch 2 Y
26 Other Provider Identifier 1 200436850A Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
27 Other Provider Identifier Type Code 1 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
28 Other Provider Identifier State 1 OK
29 Other Provider Identifier 2 2135608 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
30 Other Provider Identifier Type Code 2 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
31 Other Provider Identifier Issuer 2 PK
32 Is Organization Subpart N

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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