Provider Demographics
NPI:1023509262
Name:DAHLKE, NICHOLAS (PHARMD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:DAHLKE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 6TH ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:IA
Mailing Address - Zip Code:50201-1826
Mailing Address - Country:US
Mailing Address - Phone:515-382-2485
Mailing Address - Fax:515-382-3473
Practice Address - Street 1:1002 6TH ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:IA
Practice Address - Zip Code:50201-1826
Practice Address - Country:US
Practice Address - Phone:515-382-2485
Practice Address - Fax:515-382-3473
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist