Healthcare Provider Details

I. General information

NPI: 1134194434
Provider Name (Legal Business Name): GREGORY PETER DYKE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N NORTHWEST HWY SUITE 145
PARK RIDGE IL
60068-3263
US

IV. Provider business mailing address

444 N NORTHWEST HWY SUITE 145
PARK RIDGE IL
60068-3263
US

V. Phone/Fax

Practice location:
  • Phone: 847-685-9900
  • Fax: 847-685-6390
Mailing address:
  • Phone: 847-685-9900
  • Fax: 847-685-6390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: