Provider Demographics
NPI:1003943176
Name:LJC,INC DBA STONE DRUG
Entity Type:Organization
Organization Name:LJC,INC DBA STONE DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FISHER
Authorized Official - Last Name:CROOK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:307-733-9768
Mailing Address - Street 1:PO BOX 9000
Mailing Address - Street 2:830 WEST BROADWAY
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-9000
Mailing Address - Country:US
Mailing Address - Phone:307-733-9768
Mailing Address - Fax:
Practice Address - Street 1:830 WEST BROADWAY
Practice Address - Street 2:BOX 9000
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:307-733-9768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY52-023563336C0003X
WY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY52-02356OtherWY RETAIL PHARMACY LICENS
WY1500OtherWY WHOLESALER-DISTRIBUTER
WY1500OtherWY WHOLESALER-DISTRIBUTER
WY1500OtherWY WHOLESALER-DISTRIBUTER