Organization
JACK JUSTICE
Active
Other names
Reavis Rexall Drug
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK LEE JUSTICE DPH (OWNER PHARMACIST)
(405) 238-7391
Entity
Organization
Contact information
Practice address
110 BURR AVE, PAULS VALLEY, OK 73075-3848
(405) 238-7391
(405) 238-1162
Mailing address
110 BURR AVE, PAULS VALLEY, OK 73075-3848
(405) 238-7391
(405) 238-1162
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
223755
OK
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
223755
OK
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
223755
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100235750B
—
OK
Enumeration date
01/02/2007
Last updated
09/11/2025
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