Provider Demographics
NPI:1235546565
Name:SKINNER PHARMACIES INC
Entity Type:Organization
Organization Name:SKINNER PHARMACIES INC
Other - Org Name:PAUL JONES DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-542-4444
Mailing Address - Street 1:809 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-4751
Mailing Address - Country:US
Mailing Address - Phone:580-225-3263
Mailing Address - Fax:580-225-4216
Practice Address - Street 1:809 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-4751
Practice Address - Country:US
Practice Address - Phone:580-225-2121
Practice Address - Fax:580-225-4216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
OK35-67733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK35-8947OtherPHARMACY LICENSE
OK200545540AMedicaid
OK200545540BMedicaid
2146917OtherPK