Healthcare Provider Details

I. General information

NPI: 1013174366
Provider Name (Legal Business Name): DIELRX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 W WILLOW RD
ENID OK
73703-2433
US

IV. Provider business mailing address

915 E GARRIOTT RD
ENID OK
73701-6156
US

V. Phone/Fax

Practice location:
  • Phone: 580-234-7700
  • Fax: 580-234-7731
Mailing address:
  • Phone: 580-233-4244
  • Fax: 580-233-5319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number55299
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GRANT DIEL
Title or Position: OWNER
Credential:
Phone: 580-542-3232