Organization
JACK JUSTICE
Active
Other names
Jack's RX
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE JUSTICE (AUTHORIZED OFFICIAL)
(405) 447-3911
Entity
Organization
Contact information
Practice address
500 WILLIAMS, MAYSVILLE, OK 73057-3679
(405) 867-4427
(405) 867-5267
Mailing address
PO BOX 217, MAYSVILLE, OK 73057-0217
(405) 867-4427
(405) 867-5267
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
22-4098
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100235750D
—
OK
Enumeration date
11/21/2006
Last updated
02/05/2021
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