Provider Demographics
NPI:1134135932
Name:LOGSDON LOTZ DRUG INC
Entity Type:Organization
Organization Name:LOGSDON LOTZ DRUG INC
Other - Org Name:DONS DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:405-969-3518
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:CRESCENT
Mailing Address - State:OK
Mailing Address - Zip Code:73028-0626
Mailing Address - Country:US
Mailing Address - Phone:405-969-3518
Mailing Address - Fax:405-969-2208
Practice Address - Street 1:101 N GRAND
Practice Address - Street 2:
Practice Address - City:CRESCENT
Practice Address - State:OK
Practice Address - Zip Code:73028
Practice Address - Country:US
Practice Address - Phone:405-969-3518
Practice Address - Fax:405-969-2208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32-19533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100236800AMedicaid
2072715OtherPK