Organization
CHEYENNE PROFESSIONAL DRUG INC
Active
Other names
CITY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
EDDIE LAKEY (PRESIDENT)
(580) 928-3323
Entity
Organization
Contact information
Practice address
414 E WASHINGTON AVE, SAYRE, OK 73662-1354
(580) 928-3323
(580) 928-3321
Mailing address
PO BOX 127, SAYRE, OK 73662-0127
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
35-5042
OK
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100244930A
—
OK
01
—
2073244
PK
—
Enumeration date
07/08/2006
Last updated
07/13/2016
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