Provider Demographics
NPI:1588944045
Name:DYKES, ALTON DELANA V (RPH)
Entity type:Individual
Prefix:MR
First Name:ALTON
Middle Name:DELANA
Last Name:DYKES
Suffix:V
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 1:126 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-4815
Mailing Address - Country:US
Mailing Address - Phone:478-783-2325
Mailing Address - Fax:478-783-4706
Practice Address - Street 1:126 BROAD ST
Practice Address - Street 2:
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-4815
Practice Address - Country:US
Practice Address - Phone:478-783-4700
Practice Address - Fax:478-783-4706
Is Sole Proprietor?:No
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH009241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist