Provider Demographics
NPI:1063519619
Name:DICK, ANDREW (RPH)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:DICK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 KEY DEER BLVD
Mailing Address - Street 2:
Mailing Address - City:BIG PINE KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33043-4906
Mailing Address - Country:US
Mailing Address - Phone:305-872-4850
Mailing Address - Fax:305-872-4995
Practice Address - Street 1:251 KEY DEER BLVD
Practice Address - Street 2:
Practice Address - City:BIG PINE KEY
Practice Address - State:FL
Practice Address - Zip Code:33043-4906
Practice Address - Country:US
Practice Address - Phone:305-872-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0029905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032502300Medicaid
FL0556050984Medicare NSC