Organization
LAVERNE PHARMACY MANAGEMENT INC
Active
Other names
Medic Pharmacy & Gifts
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN BELL RPH (PIC)
(580) 921-3373
Entity
Organization
Contact information
Practice address
102 W JANE JAYROE, LAVERNE, OK 73848-1250
(580) 921-3373
(580) 921-5469
Mailing address
PO BOX 1250, LAVERNE, OK 73848-1250
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
715126
OK
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100810930B
—
OK
01
—
2074719
PK
—
Enumeration date
11/20/2006
Last updated
02/12/2015
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