Provider Demographics
NPI:1205356383
Name:RLM PHARMACY, LLC
Entity Type:Organization
Organization Name:RLM PHARMACY, LLC
Other - Org Name:JONES DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-341-1504
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:JONES
Mailing Address - State:OK
Mailing Address - Zip Code:73049
Mailing Address - Country:US
Mailing Address - Phone:495-399-2277
Mailing Address - Fax:405-399-3277
Practice Address - Street 1:101 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JONES
Practice Address - State:OK
Practice Address - Zip Code:73049
Practice Address - Country:US
Practice Address - Phone:405-399-2277
Practice Address - Fax:405-399-3277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
OK1-7789333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2169817OtherPK
OK200736620AMedicaid