Provider Demographics
NPI:1285921817
Name:DICKSON, MARISSA A (PHARMD)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:A
Last Name:DICKSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 BLUE VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2639
Mailing Address - Country:US
Mailing Address - Phone:913-327-7743
Mailing Address - Fax:913-327-7743
Practice Address - Street 1:12200 BLUE VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2639
Practice Address - Country:US
Practice Address - Phone:913-327-7743
Practice Address - Fax:913-327-7743
Is Sole Proprietor?:No
Enumeration Date:2011-07-04
Last Update Date:2011-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist