Provider Demographics
NPI:1275135600
Name:LANIG, DAVID JASON (PHARM D)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JASON
Last Name:LANIG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9366 S CHILDRENS LN
Mailing Address - Street 2:
Mailing Address - City:CADDO
Mailing Address - State:OK
Mailing Address - Zip Code:74729-5059
Mailing Address - Country:US
Mailing Address - Phone:580-920-9570
Mailing Address - Fax:
Practice Address - Street 1:872 W 13TH ST
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-3426
Practice Address - Country:US
Practice Address - Phone:580-889-3331
Practice Address - Fax:580-889-7765
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist