Provider Demographics
NPI:1619074580
Name:LAKEY, EDDIE TOM II (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:TOM
Last Name:LAKEY
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N ELECTRA ST
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:OK
Mailing Address - Zip Code:73662-1307
Mailing Address - Country:US
Mailing Address - Phone:580-374-1615
Mailing Address - Fax:580-928-3635
Practice Address - Street 1:414 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:OK
Practice Address - Zip Code:73662-1354
Practice Address - Country:US
Practice Address - Phone:580-928-3323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13662183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist