Provider Demographics
NPI:1013174366
Name:DIELRX
Entity Type:Organization
Organization Name:DIELRX
Other - Org Name:FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-542-3232
Mailing Address - Street 1:915 E GARRIOTT RD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-6156
Mailing Address - Country:US
Mailing Address - Phone:580-233-4244
Mailing Address - Fax:580-233-5319
Practice Address - Street 1:2311 W WILLOW RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-2433
Practice Address - Country:US
Practice Address - Phone:580-234-7700
Practice Address - Fax:580-234-7731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK552993336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2077201OtherPK
OK200201750BMedicaid