Provider Demographics
NPI:1598496143
Name:DYCHES, MARY JO (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:DYCHES
Suffix:
Gender:F
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:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:PEAK
Mailing Address - State:SC
Mailing Address - Zip Code:29122-0039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 RIVER STREET
Practice Address - Street 2:
Practice Address - City:PEAK
Practice Address - State:SC
Practice Address - Zip Code:29122
Practice Address - Country:US
Practice Address - Phone:803-345-1707
Practice Address - Fax:803-345-8952
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6826183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist