Provider Demographics
NPI:1194098467
Name:VANDYKE, DENNIS MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:MICHAEL
Last Name:VANDYKE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S OCEAN BLVD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-6668
Mailing Address - Country:US
Mailing Address - Phone:954-942-1866
Mailing Address - Fax:866-709-4405
Practice Address - Street 1:1201 S OCEAN BLVD
Practice Address - Street 2:SUITE 14
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-6668
Practice Address - Country:US
Practice Address - Phone:954-942-1866
Practice Address - Fax:866-709-4405
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS24195OtherPHARMACY LICENSE