Healthcare Provider Details

I. General information

NPI: 1487014999
Provider Name (Legal Business Name): JOANN VAN DYK-ADAMS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 WESTGATE RD
EAU CLAIRE WI
54703-4964
US

IV. Provider business mailing address

1707 WESTGATE RD
EAU CLAIRE WI
54703-4964
US

V. Phone/Fax

Practice location:
  • Phone: 715-838-5856
  • Fax: 715-838-5861
Mailing address:
  • Phone: 715-838-5856
  • Fax: 715-838-5861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9355-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: