Healthcare Provider Details

I. General information

NPI: 1477660512
Provider Name (Legal Business Name): DYKSTRA PHARMACY CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 MAIN STREET BOX 309
HULL IA
51239
US

IV. Provider business mailing address

1044 MAIN ST BOX 309
HULL IA
51238
US

V. Phone/Fax

Practice location:
  • Phone: 712-439-1611
  • Fax: 712-439-1612
Mailing address:
  • Phone: 712-439-1611
  • Fax: 712-439-1612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number14742
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number14742
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number14742
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14742
License Number StateIA

VIII. Authorized Official

Name: MR. RICHARD K DYKSTRA
Title or Position: OWNER
Credential: RPH
Phone: 712-439-1611