Healthcare Provider Details

I. General information

NPI: 1821126442
Provider Name (Legal Business Name): LEWIS-MCFALLS PHARMACY .INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 E JOSEPHINE AVE
FREDERICK OK
73542-2017
US

IV. Provider business mailing address

219 E JOSEPHINE AVE
FREDERICK OK
73542-2017
US

V. Phone/Fax

Practice location:
  • Phone: 580-335-7575
  • Fax:
Mailing address:
  • Phone: 580-335-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number42-4704
License Number StateOK

VIII. Authorized Official

Name: MR. ROBERT KEITH LEWIS
Title or Position: PRESIDENT PHARMACIST
Credential: PHD.
Phone: 580-335-7575