Healthcare Provider Details

I. General information

NPI: 1992304505
Provider Name (Legal Business Name): JAMES DYKES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9215 BROADWAY ST STE 113
PEARLAND TX
77584-8987
US

IV. Provider business mailing address

9215 BROADWAY ST STE 113
PEARLAND TX
77584-8987
US

V. Phone/Fax

Practice location:
  • Phone: 281-741-5825
  • Fax: 281-741-2532
Mailing address:
  • Phone: 281-741-5825
  • Fax: 281-741-2532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number36405
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: