Organization
JINNY ANN 4 CORPORATION
Active
Other names
LASSITER DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN LASSITER (PRESIDENT)
(405) 677-0549
Entity
Organization
Contact information
Practice address
3252 SE 29TH ST, DEL CITY, OK 73115-1601
(405) 677-0549
(405) 672-0369
Mailing address
PO BOX 15330, DEL CITY, OK 73155-5330
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
13455
OK
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100232680A
—
OK
05
—
100232680B
—
OK
01
—
2081564
PK
—
Enumeration date
09/20/2006
Last updated
05/24/2016
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