Healthcare Provider Details

I. General information

NPI: 1548306368
Provider Name (Legal Business Name): FIKES PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E. 2ND STREET
GRANDFIELD OK
73546
US

IV. Provider business mailing address

PO BOX 159
GRANDFIELD OK
73546-0159
US

V. Phone/Fax

Practice location:
  • Phone: 580-479-5696
  • Fax: 580-479-5662
Mailing address:
  • Phone: 580-479-5696
  • Fax: 580-479-5662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number42-4672
License Number StateOK

VIII. Authorized Official

Name: AMY B FIKES
Title or Position: OWNER
Credential:
Phone: 580-479-5696