Provider Demographics
NPI:1790477859
Name:NEWBERRY EXPRESS PHARMACY, LLC
Entity Type:Organization
Organization Name:NEWBERRY EXPRESS PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:RITTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-889-0230
Mailing Address - Street 1:744 S MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-3355
Mailing Address - Country:US
Mailing Address - Phone:580-889-3353
Mailing Address - Fax:580-889-3060
Practice Address - Street 1:801 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MARLOW
Practice Address - State:OK
Practice Address - Zip Code:73055-3433
Practice Address - Country:US
Practice Address - Phone:580-658-3784
Practice Address - Fax:580-658-3725
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEWBERRY EXPRESS PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy