Provider Demographics
NPI:1104477421
Name:DYKE, M KATHLEEN (RPH)
Entity type:Individual
Prefix:
First Name:M
Middle Name:KATHLEEN
Last Name:DYKE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:M
Other - Middle Name:KATHY
Other - Last Name:DYKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1901 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK FALLS
Mailing Address - State:IL
Mailing Address - Zip Code:61071-3504
Mailing Address - Country:US
Mailing Address - Phone:815-626-6803
Mailing Address - Fax:815-626-6818
Practice Address - Street 1:1901 1ST AVE
Practice Address - Street 2:
Practice Address - City:ROCK FALLS
Practice Address - State:IL
Practice Address - Zip Code:61071-3504
Practice Address - Country:US
Practice Address - Phone:815-626-6803
Practice Address - Fax:815-626-6818
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.036943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist