MEDICARE: MR. SUNDAY E. DIKE R.PH

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	183500000X	Pharmacist	25284	TX
2	1835P1200X	Pharmacotherapy Pharmacist	25284	TX

General Provider Information

NPI Number	:	1578891610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SUNDAY E. DIKE R.PH

Provider Business Mailing Address
First Line	:	1515 LOCKWOOD DRIVE
Second Line	:	WALGREENS STORE 2686
City	:	HOUSTON
State	:	TX
Zip	:	77020
Country	:	US
Telephone Number	:	281-648-3388
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 LOCKWOOD DRIVE
Second Line	:	WALGREENS STORE 2686
City	:	HOUSTON
State	:	TX
Zip	:	77020
Country	:	US
Telephone Number	:	713-674-7465
Fax Number	:	713-674-1401

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

Provider Enumeration Date	:	12/01/2009
Last Update Date	:	12/01/2009

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