Organization
SCOTTS PHARMACY LLC
Active
Other names
Valu-Med Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN BLAKE WILSON (OWNER)
(405) 741-1200
Entity
Organization
Contact information
Practice address
1201 S LEE ST, FORT GIBSON, OK 74434
(918) 478-3002
(918) 478-3017
Mailing address
PO BOX 967, FORT GIBSON, OK 74434-0967
(918) 478-3002
(918) 478-3017
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
4-6086
OK
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100238350A
—
OK
01
—
2124412
PK
—
Enumeration date
09/06/2006
Last updated
11/10/2021
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