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Individual
LORA LEE VAN DYKE
Active
Individual
LORA LEE VAN DYKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARM D
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
118797
MN
183500000X
Pharmacist
19216
IA
183500000X
Pharmacist
Primary
4117
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4117
PHARMACIST LICENSE
SD
Enumeration date
01/19/2012
Last updated
03/04/2021
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