Provider Demographics
NPI:1962519900
Name:FIKES, CORY (DPH)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:FIKES
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GRANDFIELD
Mailing Address - State:OK
Mailing Address - Zip Code:73546-9155
Mailing Address - Country:US
Mailing Address - Phone:580-479-5520
Mailing Address - Fax:580-479-5662
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:580-479-5662
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist