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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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