MEDICARE: DR. EDDIE TOM LAKEY II PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	13662	OK

General Provider Information

NPI Number	:	1619074580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDDIE TOM LAKEY II PHARMD

Provider Business Mailing Address
First Line	:	1501 N ELECTRA ST
Second Line	:
City	:	SAYRE
State	:	OK
Zip	:	73662-1307
Country	:	US
Telephone Number	:	580-374-1615
Fax Number	:	580-928-3635

Provider Business Practice Location Address
First Line	:	414 E WASHINGTON AVE
Second Line	:
City	:	SAYRE
State	:	OK
Zip	:	73662-1354
Country	:	US
Telephone Number	:	580-928-3323
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2019

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