Organization
DYKSTRA DRUG STORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS D KLAASEN RPH (OWNER/PRESIDENT)
(616) 392-8130
Entity
Organization
Contact information
Practice address
91 DOUGLAS AVE, HOLLAND, MI 49424-2188
(616) 392-8130
(616) 392-8025
Mailing address
91 DOUGLAS AVE, PO BOX 8249, HOLLAND, MI 49424-2188
(616) 392-8130
(616) 392-8025
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301001241
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2328587
NCPDP
MI
05
—
2328587
—
MI
05
—
4294122
—
MI
Enumeration date
05/11/2006
Last updated
08/22/2020
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