Organization
SKY LAKES MEDICAL CENTER INC
Active
Other names
Sky Lakes Outpatient Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD RICO (CFO)
(541) 274-6150
Entity
Organization
Contact information
Practice address
2865 DAGGETT AVE, KLAMATH FALLS, OR 97601-1106
(541) 274-3491
(541) 274-3495
Mailing address
2865 DAGGETT AVE, KLAMATH FALLS, OR 97601-1106
(541) 274-3491
(541) 274-3495
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
RP0002929
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2146304
PK
—
Enumeration date
06/17/2014
Last updated
06/22/2015
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