Organization Name: | CHEYENNE PROFESSIONAL DRUG, INC |
NPI Number: | 1104851989 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | EDDIE LAKEY (OWNER) |
Mailing Address: | 1505 Watts St Sayre |
State: | OK US |
Postal Code: | 736621312 |
Phone Number: | 5809283633 |
Fax Number: | 5809283635 |
NPI Enumeration Date: | 07/11/2006 |
NPI Last Update Date: | 10/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 3336C0004X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Pharmacy |
Taxonomy Specialization: | Compounding Pharmacy |
Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |