Healthcare Provider Details

I. General information

NPI: 1932986544
Provider Name (Legal Business Name): KIMBERLY KAYE DYKSTRA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 PARK ST
SHELDON IA
51201-1202
US

IV. Provider business mailing address

814 3RD ST
HULL IA
51239-7395
US

V. Phone/Fax

Practice location:
  • Phone: 712-324-4331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24846
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: