MEDICARE: LYONS DRUG AND GIFT

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
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	653605	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3718585	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1588745830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYONS DRUG AND GIFT

Provider Business Mailing Address
First Line	:	112 S BROADWAY ST
Second Line	:
City	:	WALTERS
State	:	OK
Zip	:	73572-2033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 S BROADWAY ST
Second Line	:
City	:	WALTERS
State	:	OK
Zip	:	73572-2033
Country	:	US
Telephone Number	:	580-875-3188
Fax Number	:	580-875-3229

Authorized Official
Title or Position	:	OWNER PHCST
Name	:	MITZIE LYONS
Credential	:
Telephone Number	:	580-875-3188

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	09/11/2025

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Directions to “LYONS DRUG AND GIFT ” Practice Location

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