Provider Demographics
NPI:1730463688
Name:LAND, DYKIESHA WILLETTE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DYKIESHA
Middle Name:WILLETTE
Last Name:LAND
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 CORDOVA GREEN DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-1819
Mailing Address - Country:US
Mailing Address - Phone:901-276-5491
Mailing Address - Fax:
Practice Address - Street 1:1359 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2007
Practice Address - Country:US
Practice Address - Phone:901-276-5491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist