Provider Demographics
NPI:1457487704
Name:DYKES, CURTIS RALPH (RPH)
Entity Type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:RALPH
Last Name:DYKES
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 1:1220 LASALLE ST
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-5158
Mailing Address - Country:US
Mailing Address - Phone:601-684-4541
Mailing Address - Fax:601-684-4003
Practice Address - Street 1:1220 LASALLE ST
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-5158
Practice Address - Country:US
Practice Address - Phone:601-684-4541
Practice Address - Fax:601-684-4003
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE5870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSE5870OtherLICENSE