Organization
PRUETTS FOOD INC
Active
Other names
PRUETTS FOOD-PHARMACY#3
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON JEWELANNA PRUETT (PHARMACY DIRECTOR)
(580) 584-6089
Entity
Organization
Contact information
Practice address
500 E COLLIN RAYE DR, DE QUEEN, AR 71832-8048
(870) 642-5680
(870) 642-5683
Mailing address
210 MAIN STREET, BROKEN BOW, OK 74728-4737
(870) 648-5680
(870) 648-5683
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR14401
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190021407A
—
AR
05
—
20001990D
—
OK
01
—
2132858
PK
—
Enumeration date
11/28/2011
Last updated
01/31/2021
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up