Provider Demographics
NPI:1265628747
Name:DYKSTRA, EMILY J (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:DYKSTRA
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31702 GRANITE AVE
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:IA
Mailing Address - Zip Code:51024-9091
Mailing Address - Country:US
Mailing Address - Phone:712-239-5085
Mailing Address - Fax:
Practice Address - Street 1:31702 GRANITE AVE
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:IA
Practice Address - Zip Code:51024-9091
Practice Address - Country:US
Practice Address - Phone:712-239-5085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16706183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist