MEDICARE: DR. DOWNER PACE DYKES III PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835G0303X	Geriatric Pharmacist	RP0011737	WV
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	RP0011737	WV
3	1835P2201X	Ambulatory Care Pharmacist	RP0011737	WV
4	183500000X	Pharmacist	RP0011737	WV

General Provider Information

NPI Number	:	1245872969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOWNER PACE DYKES III PHARMD

Provider Business Mailing Address
First Line	:	202 9TH AVE W
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-2529
Country	:	US
Telephone Number	:	214-564-3386
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 9TH AVE W
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-2529
Country	:	US
Telephone Number	:	214-564-3386
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2019
Last Update Date	:	10/14/2019

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