Provider Demographics
NPI:1659090249
Name:FIKES, BRADYN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRADYN
Middle Name:
Last Name:FIKES
Suffix:
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 1:101 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GRANDFIELD
Mailing Address - State:OK
Mailing Address - Zip Code:73546
Mailing Address - Country:US
Mailing Address - Phone:580-479-5696
Mailing Address - Fax:
Practice Address - Street 1:101 E 2ND ST
Practice Address - Street 2:
Practice Address - City:GRANDFIELD
Practice Address - State:OK
Practice Address - Zip Code:73546
Practice Address - Country:US
Practice Address - Phone:580-479-5696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist