Provider Demographics
NPI:1982698585
Name:T & L PHARMACY INC.
Entity Type:Organization
Organization Name:T & L PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-735-2161
Mailing Address - Street 1:1001 HWY 64 NORTH
Mailing Address - Street 2:P.O.BOX 120
Mailing Address - City:BUFFALO
Mailing Address - State:OK
Mailing Address - Zip Code:73834-0120
Mailing Address - Country:US
Mailing Address - Phone:580-735-2161
Mailing Address - Fax:580-735-2230
Practice Address - Street 1:506 NORTH HOY
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:OK
Practice Address - Zip Code:73834
Practice Address - Country:US
Practice Address - Phone:580-735-2161
Practice Address - Fax:580-735-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK713536333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3704043OtherNABP
OK100238560AMedicaid
OK0384010001Medicare ID - Type Unspecified