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REAVIS SUPER DRUG
NPI 1699772806
Pharmacy - Community/Retail Pharmacy in Pauls Valley, OK

Active since July 01, 2005CLIA 37D2236956 · Waiver
110 A BURR AVE, PAULS VALLEY, OK 73075(405) 238-7391(405) 238-7357 Get Directions Write a Review

NPPES record last updated: October 28, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Reavis Super Drug NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

REAVIS SUPER DRUG (NPI 1699772806) is a healthcare organization registered as a community/retail pharmacy in Pauls Valley, Oklahoma and active in the NPI registry since July 2005. The organization holds a CLIA Waiver certificate valid through September 20, 2027 and lists Julie Justice, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1699772806
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameJACK JUSTICE
Location Address110 A BURR AVEPauls Valley, OK 73075-1220
Mailing AddressPo Box 1220Pauls Valley, OK 73075-2020 · (405) 238-7391 · Fax (405) 238-1162
Phone(405) 238-7391
Fax(405) 238-7357
Organization SubpartNo
Authorized OfficialJulie JusticeAuthorized Official · (405) 447-3911
Enumeration DateJuly 1, 2005
Last NPPES UpdateOctober 28, 2024
NPPES CertifiedOctober 28, 2024
✔ NPI 1699772806 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in OK · 22-3755
Definition
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X
Also ListedPharmacy · Compounding PharmacyTaxonomy 3336C0004X
110 A BURR AVE, Pauls Valley, OK 73075
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Other Names 1

Doing Business AsReavis Super Drug

Other Identifiers 2

Other2073053Pk
Medicaid100235750AOK

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 37D2236956

Reavis Drug · Pauls Valley, OK
Active · expires Sep 20, 2027
CLIA Number37D2236956
Laboratory TypePharmacy
Certificate Effective DateSeptember 21, 2025
Certificate Expiration DateSeptember 20, 2027
Laboratory DirectorSara Justice
Laboratory Phone(405) 238-7391
Laboratory LocationReavis Drug110 Burr Ave, Pauls Valley, OK 73075
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
67 services67 patients
Influenza vaccine split virus, preservative free 90662
The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
64 services64 patients
Administration of pneumococcal vaccine G0009
The pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.
14 services14 patients
Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use 90677
The Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.
12 services12 patients

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack Justice's NPI number?

The NPI number for Jack Justice is 1699772806. It was assigned to this organization in the NPPES registry on July 1, 2005. The provider is doing business as Reavis Super Drug.

Where is Jack Justice located?

Jack Justice is located at 110 A Burr Ave, Pauls Valley, OK 73075. The listed phone number is (405) 238-7391.

What is Jack Justice's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Does Jack Justice hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 37D2236956) is associated with this NPI, valid through September 20, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Jack Justice accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arizona Complete Health and 50 other insurers list Jack Justice as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jack Justice was last updated on October 28, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.