Provider Demographics
NPI:1265060081
Name:M & L PHARMACY, LLC
Entity type:Organization
Organization Name:M & L PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:W
Authorized Official - Last Name:LANGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:405-737-3451
Mailing Address - Street 1:7201 E RENO AVE STE A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4484
Mailing Address - Country:US
Mailing Address - Phone:405-737-3451
Mailing Address - Fax:405-733-7061
Practice Address - Street 1:7201 E RENO AVE STE A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4484
Practice Address - Country:US
Practice Address - Phone:405-737-3451
Practice Address - Fax:405-733-7061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-28
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1-9076OtherOKLAHOMA STATE BOARD OF PHARMACY LICENSE NUMBER
OK100235220AMedicaid