Provider Demographics
NPI:1891198719
Name:VANDYKE, ADA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ADA
Middle Name:
Last Name:VANDYKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ADA
Other - Middle Name:
Other - Last Name:VANDYKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3318 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-4114
Mailing Address - Country:US
Mailing Address - Phone:480-274-6122
Mailing Address - Fax:
Practice Address - Street 1:5975 W RAY RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-1827
Practice Address - Country:US
Practice Address - Phone:480-214-9120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020511183500000X
TX52182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist