Provider Demographics
NPI:1073113049
Name:DYKE, WAYNE ALDEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:ALDEN
Last Name:DYKE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 FARMSTEAD RD
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2816
Mailing Address - Country:US
Mailing Address - Phone:443-750-1111
Mailing Address - Fax:
Practice Address - Street 1:9750 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4147
Practice Address - Country:US
Practice Address - Phone:443-394-0987
Practice Address - Fax:443-394-0970
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06991183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist