Provider Demographics
NPI:1609145556
Name:DYER, DAVID (PHARM D)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DYER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-4211
Mailing Address - Country:US
Mailing Address - Phone:402-362-1280
Mailing Address - Fax:402-362-1355
Practice Address - Street 1:533 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-4211
Practice Address - Country:US
Practice Address - Phone:402-362-1280
Practice Address - Fax:402-362-1355
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11290183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist