Healthcare Provider Details

I. General information

NPI: 1326370941
Provider Name (Legal Business Name): LISA ANN DYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA ANN OLSON

II. Dates (important events)

Enumeration Date: 02/06/2010
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER ST
SAN ANTONIO TX
78229-4404
US

IV. Provider business mailing address

7400 MERTON MINTER ST
SAN ANTONIO TX
78229-4404
US

V. Phone/Fax

Practice location:
  • Phone: 210-617-5300
  • Fax:
Mailing address:
  • Phone: 210-617-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13105
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number13105
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number13105
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: