Provider Demographics
NPI:1386934222
Name:VAN WYK, RHYNHARDT
Entity type:Individual
Prefix:MRS
First Name:RHYNHARDT
Middle Name:
Last Name:VAN WYK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 CLAIBORNE RUN
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7811
Mailing Address - Country:US
Mailing Address - Phone:270-344-2144
Mailing Address - Fax:
Practice Address - Street 1:115 STATE ROUTE 81 N
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:KY
Practice Address - Zip Code:42327-2101
Practice Address - Country:US
Practice Address - Phone:270-273-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist