PRUETTS FOOD-PHARMACY#3 – Community/Retail Pharmacy, NPI 1659648285
Community/Retail Pharmacy
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for PRUETTS FOOD-PHARMACY#3
201 S PARK DR
BROKEN BOW, OK 747284737
Phone: (580) 584-6056
Fax: (580) 584-6088
Type: Mailing
500 E COLLIN RAYE DR
DE QUEEN, AR 718328048
Phone: (870) 642-5680
Fax: (870) 642-5683
Type: Location
210 MAIN STREET
BROKEN BOW, OK 747284737
Phone: (870) 648-5680
Fax: (870) 648-5683
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2016-08-09
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-08-31 (1017 days ago).
Enrollment records
1
Earliest due date
2023-08-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20160809002724 | O | Mass Immunization (Roster Biller Only) | AR | 2023-08-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| G0008 | Administration of influenza virus vaccine | 28 | 28 | $0 |
| 90662 | Influenza vaccine split virus, preservative free | 26 | 26 | $0 |
Insurance plans in this area (ZIP 74728)
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