Provider Demographics
NPI:1992304505
Name:DYKES, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:DYKES
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 1:9215 BROADWAY ST STE 113
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8987
Mailing Address - Country:US
Mailing Address - Phone:281-741-5825
Mailing Address - Fax:281-741-2532
Practice Address - Street 1:9215 BROADWAY ST STE 113
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8987
Practice Address - Country:US
Practice Address - Phone:281-741-5825
Practice Address - Fax:281-741-2532
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist