Provider Demographics
NPI:1952475345
Name:FIKES PHARMACY INC
Entity Type:Organization
Organization Name:FIKES PHARMACY INC
Other - Org Name:FIKES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:FIKES
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-479-5696
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:GRANDFIELD
Mailing Address - State:OK
Mailing Address - Zip Code:73546-0159
Mailing Address - Country:US
Mailing Address - Phone:580-479-5696
Mailing Address - Fax:580-479-5662
Practice Address - Street 1:101 E 2ND STREET
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:580-479-5662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23981332B00000X
333600000X, 3336C0003X, 3336C0004X
OK4246723336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2076174OtherPK
OK90003930377Medicaid
OK100245210AMedicaid
TX580095Medicaid
TX580095Medicaid