Healthcare Provider Details

I. General information

NPI: 1013291897
Provider Name (Legal Business Name): DINORAH ISABEL DYKSTRA PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 68TH ST SW
BYRON CENTER MI
49315-8372
US

IV. Provider business mailing address

701 68TH ST SW
BYRON CENTER MI
49315-8372
US

V. Phone/Fax

Practice location:
  • Phone: 616-281-7605
  • Fax: 616-281-7608
Mailing address:
  • Phone: 616-281-7605
  • Fax: 616-281-7608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302029376
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: