LAWTON CBOC PHARMACY (4177)    INSTITUTION (4)

Name Value
NAME LAWTON CBOC PHARMACY
STATE OKLAHOMA
STREET ADDR. 1 BLDG. 4303 PITTMAN & THOMAS
CITY FT. SILL
ZIP 73503-4473
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME LAWTON VA CBOC PHARMACY
ST. ADDR. 1 (MAILING) BLDG. 4303 PITTMAN & THOMAS
CITY (MAILING) FT. SILL
STATE (MAILING) OKLAHOMA
ZIP (MAILING) 73503-4473
EFFECTIVE DATE/TIME
  • 2007-10-29 00:00:00
    STATUS:   ACTIVE
    NPI:   1750583563
TAXONOMY CODE
  • Suppliers
    PRIMARY CODE:   YES
    STATUS:   ACTIVE
LOCATION TIMEZONE CENTRAL
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA