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General NPI Number Information
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NPI Number | 1003943176
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Entity Type | Organization
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Legal Business Name | LJC,INC DBA STONE DRUG
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 830 WEST BROADWAY BOX 9000
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City | JACKSON
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State | WY
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Zip | 83001
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Country | US
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Telephone | 307-733-9768
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9000 830 WEST BROADWAY
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City | JACKSON
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State | WY
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Zip | 83002-9000
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Country | US
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Telephone | 307-733-9768
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, PIC
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Name | MR. JOHN FISHER CROOK
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Credential | RPH
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Telephone | 307-733-9768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 52-02356
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | WY
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