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General NPI Number Information
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NPI Number | 1821274416
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Entity Type | Organization
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Legal Business Name | CHEYENNE PROFESSIONAL DRUG, INC
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Dates
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Enumeration Date | 01/14/2008
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Last Update Date | 11/08/2009
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Provider Practice Location Address
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Address Line | 111 N 4TH ST
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City | SAYRE
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State | OK
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Zip | 73662-2917
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Country | US
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Telephone | 580-928-2741
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Fax | 580-928-2743
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Provider Business Mailing Address
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Address Line | 111 N 4TH ST
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City | SAYRE
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State | OK
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Zip | 73662-2917
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Country | US
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Telephone | 580-928-2741
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Fax | 580-928-2743
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Authorized Official
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Title or Position | OWNER
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Name | MR. EDDIE TOM LAKEY I
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Credential | RPH
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Telephone | 580-928-2741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 761461
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License Number State | OK
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