Provider Demographics
NPI:1528384476
Name:VAN DYK, CAREL LEROUX (RPH)
Entity Type:Individual
Prefix:
First Name:CAREL
Middle Name:LEROUX
Last Name:VAN DYK
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 1:111 ALAMEDA CIR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-4363
Mailing Address - Country:US
Mailing Address - Phone:704-660-2281
Mailing Address - Fax:
Practice Address - Street 1:111 ALAMEDA CIR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-4363
Practice Address - Country:US
Practice Address - Phone:704-660-2281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-18
Last Update Date:2010-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist