Healthcare Provider Details

I. General information

NPI: 1154244085
Provider Name (Legal Business Name): LAVERNE PHARMACY MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W JANE JAYROE
LAVERNE OK
73848-1250
US

IV. Provider business mailing address

102 W JANE JAYROE
LAVERNE OK
73848-1250
US

V. Phone/Fax

Practice location:
  • Phone: 580-921-3373
  • Fax:
Mailing address:
  • Phone: 580-921-3373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRYAN WESLEY BELL
Title or Position: PIC
Credential:
Phone: 580-921-3373