Provider Demographics
NPI:1932986544
Name:DYKSTRA, KIMBERLY KAYE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAYE
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 1:814 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:IA
Mailing Address - Zip Code:51239-7395
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 PARK ST
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:IA
Practice Address - Zip Code:51201-1202
Practice Address - Country:US
Practice Address - Phone:712-324-4331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist