MEDICARE: LONE GROVE DRUG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	123540	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3712470	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1598822934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONE GROVE DRUG

Provider Business Mailing Address
First Line	:	PO BOX 1019
Second Line	:
City	:	LONE GROVE
State	:	OK
Zip	:	73443-1019
Country	:	US
Telephone Number	:	580-657-3555
Fax Number	:	580-657-8259

Provider Business Practice Location Address
First Line	:	16662 US HWY 70
Second Line	:
City	:	LONE GROVE
State	:	OK
Zip	:	73443-1019
Country	:	US
Telephone Number	:	580-657-3555
Fax Number	:	580-657-8259

Authorized Official
Title or Position	:	OWNER AND PHARMACIST
Name	:	JOHN DELANO
Credential	:	RPH
Telephone Number	:	580-657-3555

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	11/05/2010

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Directions to “LONE GROVE DRUG ” Practice Location

Language	Start Address	Practice Location

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