Healthcare Provider Details

I. General information

NPI: 1619074580
Provider Name (Legal Business Name): EDDIE TOM LAKEY II PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 E WASHINGTON AVE
SAYRE OK
73662-1354
US

IV. Provider business mailing address

1501 N ELECTRA ST
SAYRE OK
73662-1307
US

V. Phone/Fax

Practice location:
  • Phone: 580-928-3323
  • Fax:
Mailing address:
  • Phone: 580-374-1615
  • Fax: 580-928-3635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13662
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: