Healthcare Provider Details

I. General information

NPI: 1881016004
Provider Name (Legal Business Name): BARBARA JO DYKEMA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 S. WESTNEDGE
KALAMAZOO MI
49008
US

IV. Provider business mailing address

8857 TAMARISK CIR
RICHLAND MI
49083-8607
US

V. Phone/Fax

Practice location:
  • Phone: 269-337-2110
  • Fax:
Mailing address:
  • Phone: 269-629-0331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302029840
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: