Provider Demographics
NPI:1801164009
Name:DYKES, KENNETH RAY (RPH)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:RAY
Last Name:DYKES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78202-3007
Mailing Address - Country:US
Mailing Address - Phone:210-354-3993
Mailing Address - Fax:210-354-2496
Practice Address - Street 1:2200 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78202-3007
Practice Address - Country:US
Practice Address - Phone:210-354-3993
Practice Address - Fax:210-354-2496
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist