Organization
PUCKETT FOOD STORES INC
Active
Other names
PUCKETT DISCOUNT DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORIA L BROOKS RPH (PHARMACY MANAGER)
(580) 782-2131
Entity
Organization
Contact information
Practice address
101 N LOUIS TITTLE AVE, MANGUM, OK 73554-4420
(580) 782-2131
(580) 782-9280
Mailing address
PO BOX 148, MANGUM, OK 73554-0148
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
60-5307
OK
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100235110B
—
OK
01
—
2073882
PK
—
Enumeration date
09/15/2005
Last updated
12/16/2019
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us