Provider Demographics
NPI:1891198719
Name:VANDYKE, ADA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ADA
Middle Name:
Last Name:VANDYKE
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ADA
Other - Middle Name:
Other - Last Name:VANDYKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:23080 ALESSANDRO BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-9675
Mailing Address - Country:US
Mailing Address - Phone:951-656-7171
Mailing Address - Fax:951-656-6363
Practice Address - Street 1:23080 ALESSANDRO BLVD STE 212
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-9675
Practice Address - Country:US
Practice Address - Phone:951-656-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52182183500000X
AZS020511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist