Provider Demographics
NPI:1376892935
Name:DIKE, CHARLES UDO NNAMDI (BPHARM)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:UDO NNAMDI
Last Name:DIKE
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:977 SHADDOCK PARK LANE
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013
Mailing Address - Country:US
Mailing Address - Phone:972-908-2270
Mailing Address - Fax:
Practice Address - Street 1:3606 LAMAR AVENUE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462
Practice Address - Country:US
Practice Address - Phone:903-785-5380
Practice Address - Fax:903-785-5846
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist