Provider Demographics
NPI:1417535691
Name:LYKE, KEITH D (RPH)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:D
Last Name:LYKE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BRAULT HILL RD
Mailing Address - Street 2:
Mailing Address - City:HIGGANUM
Mailing Address - State:CT
Mailing Address - Zip Code:06441-4442
Mailing Address - Country:US
Mailing Address - Phone:860-685-1967
Mailing Address - Fax:860-452-4278
Practice Address - Street 1:183 ROUTE 81
Practice Address - Street 2:
Practice Address - City:KILLINGWORTH
Practice Address - State:CT
Practice Address - Zip Code:06419-1480
Practice Address - Country:US
Practice Address - Phone:860-452-4275
Practice Address - Fax:860-452-4278
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist