MEDICARE: SHANNON DYKE PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP00006873	NM
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PC147	NM

General Provider Information

NPI Number	:	1942433024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON DYKE PHARM.D.

Provider Business Mailing Address
First Line	:	4605 CROYDEN AVE NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-4243
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 BECKNER RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-3641
Country	:	US
Telephone Number	:	505-772-1234
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2009
Last Update Date	:	05/04/2025

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Directions to “ SHANNON DYKE PHARM.D.” Practice Location

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