Dykstra Drug Store

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301001241 Issued in MI

Legal business name

DYKSTRA DRUG STORE

Practice address

91 Douglas Ave
Holland, MI 49424-2188

Phone

(616) 392-8130

Fax

(616) 392-8025

NPI assigned

May 11, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Thomas D Klaasen, RPH

Title

Owner/President

Phone

(616) 392-8130

Specialties & licenses 1

Addresses

Other identifiers 3

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1922058908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91 DOUGLAS AVE",
            "address_2": "PO BOX 8249",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494242188",
            "telephone_number": "616-392-8130",
            "fax_number": "616-392-8025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91 DOUGLAS AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494242188",
            "telephone_number": "616-392-8130",
            "fax_number": "616-392-8025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYKSTRA DRUG STORE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KLAASEN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "616-392-8130",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301001241",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4294122",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2328587",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2328587",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dale A Dykema, M.D.
• Liana Dykema, PMHNP
• Nathan Edward Dykema, D.P.T.
• Paul Dykema, MD
• Brian Harm Dykhuizen, ATC, LAT
• Abigail Dykstra
• Brittany Dykstra
• Claudia Dykstra
• Maria Louise Dykstra, LPC
• Russell Lee Dykstra, M.D.

• Community/Retail Pharmacy in Holland, MI
• Providers in Holland, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.