Provider Demographics
NPI:1144507492
Name:LACKEY, OLIVER GARY (PHARM D)
Entity type:Individual
Prefix:
First Name:OLIVER
Middle Name:GARY
Last Name:LACKEY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73737-1216
Mailing Address - Country:US
Mailing Address - Phone:580-227-4000
Mailing Address - Fax:580-227-4003
Practice Address - Street 1:624 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OK
Practice Address - Zip Code:73737
Practice Address - Country:US
Practice Address - Phone:580-227-4000
Practice Address - Fax:580-227-4003
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist