Healthcare Provider Details

I. General information

NPI: 1659400430
Provider Name (Legal Business Name): LOVELL DRUG COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 E MAIN ST
LOVELL WY
82431-2004
US

IV. Provider business mailing address

PO BOX 847
LOVELL WY
82431-0847
US

V. Phone/Fax

Practice location:
  • Phone: 307-548-7231
  • Fax: 307-548-7371
Mailing address:
  • Phone: 307-548-7231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5200631
License Number StateWY

VIII. Authorized Official

Name: BRENT REASCH
Title or Position: PHARMACIST AND OWNER
Credential:
Phone: 307-548-7231