Healthcare Provider Details

I. General information

NPI: 1730462839
Provider Name (Legal Business Name): THOMAS JOSEPH DYKIEL II PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2011
Last Update Date: 09/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 STATE ST
NEW ALBANY IN
47150-4921
US

IV. Provider business mailing address

1565 EDWARDSVILLE GALENA RD
GEORGETOWN IN
47122-8702
US

V. Phone/Fax

Practice location:
  • Phone: 812-945-0535
  • Fax: 812-945-8249
Mailing address:
  • Phone: 502-544-5336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26022503A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: