Healthcare Provider Details

I. General information

NPI: 1871609818
Provider Name (Legal Business Name): NEWBERRY EXPRESS PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S BROADWAY ST
MARLOW OK
73055-3433
US

IV. Provider business mailing address

744 S MISSISSIPPI AVE STE A
ATOKA OK
74525-3356
US

V. Phone/Fax

Practice location:
  • Phone: 580-658-3784
  • Fax: 580-658-3725
Mailing address:
  • Phone: 580-889-0230
  • Fax: 580-889-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RYAN JAY RITTER
Title or Position: OWNER
Credential:
Phone: 580-889-3353