# SKY LAKES MEDICAL CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sky Lakes Outpatient Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912311986
- **Authorized official:** RICHARD RICO (CFO)
- **Authorized official phone:** (541) 274-6150

## Contact information

- **Practice address:** 2865 DAGGETT AVE, KLAMATH FALLS, OR 97601-1106
- **Practice address phone:** (541) 274-3491
- **Practice address fax:** (541) 274-3495
- **Mailing address:** 2865 DAGGETT AVE, KLAMATH FALLS, OR 97601-1106
- **Mailing address phone:** (541) 274-3491
- **Mailing address fax:** (541) 274-3495

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | RP0002929 | OR | Yes |

## Other

- **Enumeration date:** 06/17/2014
- **Last updated:** 06/22/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2146304 | PK | — |