Organization
LJC,INC DBA STONE DRUG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN FISHER CROOK RPH (PRESIDENT, PIC)
(307) 733-9768
Entity
Organization
Contact information
Practice address
830 WEST BROADWAY, BOX 9000, JACKSON, WY 83001
(307) 733-9768
Mailing address
PO BOX 9000, 830 WEST BROADWAY, JACKSON, WY 83002-9000
(307) 733-9768
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
WY
3336C0003X
Community/Retail Pharmacy
Primary
52-02356
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1500
WY WHOLESALER-DISTRIBUTER
WY
01
—
52-02356
WY RETAIL PHARMACY LICENS
WY
Enumeration date
02/27/2007
Last updated
03/07/2023
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