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JACK JUSTICE NPI 1699772806


NPI Information

NPI: 1699772806
Provider Name: JACK JUSTICE

Doing Business As: REAVIS DRUG

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

CLIA Number: 37D2236956

Address:
110 A BURR AVE
PAULS VALLEY, OK
ZIP 73075
Phone: (405) 238-7391
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JACK JUSTICE is a community/retail pharmacy pharmacy in Pauls Valley, OK. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. JACK JUSTICE NPI is 1699772806. The provider is registered as an organization entity type.
The provider Is Doing Business As Reavis Drug.

The provider's business location address is:

110 A BURR AVE
PAULS VALLEY, OK
ZIP 73075-220
Phone: (405) 238-7391
Fax: (405) 238-7357

The provider's authorized official is Julie Justice .
The authorized official title is Authorized Official and has the following contact phone number (405) 447-3911.

The CLIA number assigned to this NPI record is 37D2236956 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/1/2005 and was last updated on 11/17/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. 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
13336L0003XPharmacyLong Term Care PharmacyNo
2332B00000XDurable Medical Equipment & Medical SuppliesNo
33336C0004XPharmacyCompounding PharmacyNo
43336C0003XPharmacyCommunity/Retail Pharmacy22-3755OKLAHOMAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1100235750AMEDICAIDOKLAHOMA
22073053OTHERPK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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.