Provider Demographics
NPI:1013291897
Name:DYKSTRA, DINORAH ISABEL (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:DINORAH
Middle Name:ISABEL
Last Name:DYKSTRA
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 1:701 68TH ST SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-8372
Mailing Address - Country:US
Mailing Address - Phone:616-281-7605
Mailing Address - Fax:616-281-7608
Practice Address - Street 1:701 68TH ST SW
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-8372
Practice Address - Country:US
Practice Address - Phone:616-281-7605
Practice Address - Fax:616-281-7608
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist