Healthcare Provider Details

I. General information

NPI: 1659970986
Provider Name (Legal Business Name): MICHAEL DYBVIK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2786 COMMERCIAL BLVD
CHIPPEWA FALLS WI
54729-5031
US

IV. Provider business mailing address

2786 COMMERCIAL BLVD
CHIPPEWA FALLS WI
54729-5031
US

V. Phone/Fax

Practice location:
  • Phone: 715-738-2418
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18947-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: