Basic Information
| Provider Information | |||||||||
| NPI: | 1073113049 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DYKE | ||||||||
| FirstName: | WAYNE | ||||||||
| MiddleName: | ALDEN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 FARMSTEAD RD | ||||||||
| Address2: | |||||||||
| City: | COCKEYSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210302816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437501111 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9750 REISTERSTOWN RD | ||||||||
| Address2: | |||||||||
| City: | OWINGS MILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211174147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4433940987 | ||||||||
| FaxNumber: | 4433940970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2020 | ||||||||
| LastUpdateDate: | 10/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 06991 | MD | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.