Provider Demographics
NPI:1164952875
Name:DIKAS, RAPHAEL CHINEDU (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RAPHAEL
Middle Name:CHINEDU
Last Name:DIKAS
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 1:4112 PECAN BAYOU CT
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-9662
Mailing Address - Country:US
Mailing Address - Phone:954-483-0197
Mailing Address - Fax:
Practice Address - Street 1:610 NORTH PRESTON ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:GUNTER
Practice Address - State:TX
Practice Address - Zip Code:75058-3537
Practice Address - Country:US
Practice Address - Phone:903-228-0228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50635183500000X
TX60603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist