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NPI Code Detail

MEDICARE: DIELRX

MEDICARE: DIELRX
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336L0003XLong Term Care Pharmacy
33336C0003XCommunity/Retail Pharmacy5-5533OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22125454OTHERPK

General Provider Information

NPI Number : 1043531734
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIELRX
Provider Business Mailing Address
First Line : 915 E OWEN K GARRIOTT RD
Second Line :
City : ENID
State : OK
Zip : 73701-6156
Country : US
Telephone Number : 580-233-4244
Fax Number :
Provider Business Practice Location Address
First Line : 221 S 30TH ST
Second Line :
City : ENID
State : OK
Zip : 73701-6455
Country : US
Telephone Number : 580-237-3801
Fax Number :
Authorized Official
Title or Position : OWNER
Name : GRANT DIEL
Credential :
Telephone Number : 580-542-3232
Provider Enumeration Date : 06/16/2010
Last Update Date : 05/12/2023

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Directions to “DIELRX ” Practice Location

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