Individual
JENNIFER REBECCA DYKSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM.D.
Contact information
Practice address
550 MUNSON AVE, SUITE G100, TRAVERSE CITY, MI 49686-3580
(231) 935-8730
Mailing address
1720 APACHE PASS, TRAVERSE CITY, MI 49686-2817
(231) 922-0232
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302031831
MI
Other
Enumeration date
01/05/2007
Last updated
07/08/2007
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