Provider Demographics
NPI:1073679346
Name:LASSITER ENTERPRISES INC
Entity Type:Organization
Organization Name:LASSITER ENTERPRISES INC
Other - Org Name:COMFORT CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LASSITER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:405-619-3736
Mailing Address - Street 1:PO BOX 15330
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73155-5330
Mailing Address - Country:US
Mailing Address - Phone:405-619-3736
Mailing Address - Fax:405-619-3739
Practice Address - Street 1:3001 S MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-1425
Practice Address - Country:US
Practice Address - Phone:405-619-3736
Practice Address - Fax:405-619-3739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336C0004X
OK149533336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3724449OtherNCPDP PROVIDER IDENTIFICATION NUMBER
OK100243280AMedicaid