Provider Demographics
NPI:1326591751
Name:DYKES, JOHNATHAN DAVID (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHNATHAN
Middle Name:DAVID
Last Name:DYKES
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 1:9100 MERRILL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-4358
Mailing Address - Country:US
Mailing Address - Phone:904-745-4266
Mailing Address - Fax:
Practice Address - Street 1:9100 MERRILL RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-4358
Practice Address - Country:US
Practice Address - Phone:904-745-4266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist