Reavis Rexall Drug

LBN: Jack Justice
Reavis Rexall Drug is an health care organization with primary practice located at 110 Burr Ave , Pauls Valley OK 73075-3848. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Parenteral & Enteral Nutrition, Suppliers / Oxygen Equipment & Supplies. Suppliers / Durable Medical Equipment & Medical Supplies is the primary health care specialty. Jack Justice can be contacted via phone (405) 238-7391, or through Justice, Jack Lee via phone (405) 238-7391.

Contact Information

Primary practice address
110 Burr Ave Pauls Valley OK 73075-3848
Phone: (405) 238-7391
Fax: (405) 238-1162
Website:
Map and Directions
Authorized official contact:
Name: Justice, Jack Lee Doctor of Public Health (DPH)
Phone: (405) 238-7391

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X 223755 Oklahoma
Suppliers / Parenteral & Enteral Nutrition 332BP3500X 223755 Oklahoma
Suppliers / Oxygen Equipment & Supplies 332BX2000X 223755 Oklahoma

Profile Details

NPI number 1013074111
LBN Legal business name Jack Justice
DBA Doing business as Reavis Rexall Drug
Authorized official Justice, Jack Lee Doctor of Public Health (DPH)
Entity Organization
Organization subpart 1 No
Enumeration date Jan 2nd, 2007
Last updated Aug 22nd, 2020 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013074111 NPPES
Oklahoma MEDICAID 100235750B

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