Provider Demographics
NPI:1659400430
Name:LOVELL DRUG COMPANY
Entity Type:Organization
Organization Name:LOVELL DRUG COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:REASCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-548-7231
Mailing Address - Street 1:PO BOX 847
Mailing Address - Street 2:
Mailing Address - City:LOVELL
Mailing Address - State:WY
Mailing Address - Zip Code:82431-0847
Mailing Address - Country:US
Mailing Address - Phone:307-548-7231
Mailing Address - Fax:
Practice Address - Street 1:164 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LOVELL
Practice Address - State:WY
Practice Address - Zip Code:82431-2004
Practice Address - Country:US
Practice Address - Phone:307-548-7231
Practice Address - Fax:307-548-7371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WY52006313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY104286600Medicaid
2111151OtherPK
5200631OtherOTHER ID NUMBER-COMMERCIAL NUMBER