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General NPI Number Information
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NPI Number | 1275135600
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Entity Type | Individual
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Provider Name | DAVID JASON LANIG PHARM D
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Gender | Male
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Dates
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Enumeration Date | 11/10/2020
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Last Update Date | 08/31/2022
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Provider Practice Location Address
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Address Line | 872 W 13TH ST
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City | ATOKA
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State | OK
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Zip | 74525-3426
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Country | US
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Telephone | 580-889-3331
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Fax | 580-889-7765
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Provider Business Mailing Address
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Address Line | 9366 S CHILDRENS LN
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City | CADDO
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State | OK
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Zip | 74729-5059
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Country | US
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Telephone | 580-920-9570
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 13369
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License Number State | OK
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