Healthcare Provider Details

I. General information

NPI: 1386049161
Provider Name (Legal Business Name): LESLIE MORGAN DYKES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22898 SUSSEX HWY
SEAFORD DE
19973
US

IV. Provider business mailing address

22898 SUSSEX HWY
SEAFORD DE
19973
US

V. Phone/Fax

Practice location:
  • Phone: 302-628-6100
  • Fax: 302-628-6108
Mailing address:
  • Phone: 302-628-6100
  • Fax: 302-628-6108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0004646
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22420
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: