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General NPI Number Information
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NPI Number | 1073679346
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Entity Type | Organization
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Legal Business Name | LASSITER ENTERPRISES INC
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 3001 S MANSFIELD AVE
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City | DEL CITY
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State | OK
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Zip | 73115-1425
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Country | US
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Telephone | 405-619-3736
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Fax | 405-619-3739
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Provider Business Mailing Address
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Address Line | PO BOX 15330
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City | OKLAHOMA CITY
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State | OK
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Zip | 73155-5330
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Country | US
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Telephone | 405-619-3736
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Fax | 405-619-3739
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Authorized Official
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Title or Position | MANAGER AND OWNER
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Name | JOHN LASSITER
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Credential | RPH
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Telephone | 405-619-3736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 14953
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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