Provider Demographics
NPI:1982733317
Name:THE SCRIPT SHOP INC
Entity Type:Organization
Organization Name:THE SCRIPT SHOP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:COLVIN
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-925-2106
Mailing Address - Street 1:207 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:KONAWA
Mailing Address - State:OK
Mailing Address - Zip Code:74849-2234
Mailing Address - Country:US
Mailing Address - Phone:580-925-3201
Mailing Address - Fax:580-925-3729
Practice Address - Street 1:207 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KONAWA
Practice Address - State:OK
Practice Address - Zip Code:74849-2234
Practice Address - Country:US
Practice Address - Phone:580-925-3201
Practice Address - Fax:580-925-3729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK244253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK244253OtherSTATE LICENSE
OK3711923OtherNCPDP
OK3711923OtherNCPDP
OKBT5737068OtherDEA