Provider Demographics
NPI:1598822934
Name:LONE GROVE DRUG
Entity Type:Organization
Organization Name:LONE GROVE DRUG
Other - Org Name:LONE GROVE DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DELANO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:580-657-3555
Mailing Address - Street 1:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:LONE GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:73443-1019
Mailing Address - Country:US
Mailing Address - Phone:580-657-3555
Mailing Address - Fax:580-657-8259
Practice Address - Street 1:16662 US HWY 70
Practice Address - Street 2:
Practice Address - City:LONE GROVE
Practice Address - State:OK
Practice Address - Zip Code:73443-1019
Practice Address - Country:US
Practice Address - Phone:580-657-3555
Practice Address - Fax:580-657-8259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OK1235403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100236030AMedicaid
3712470OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3712470OtherNCPDP PROVIDER IDENTIFICATION NUMBER