Provider Demographics
NPI:1699872606
Name:DICKSON, CHRISTINA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
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 1:8572 BLACK STAR CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2646
Mailing Address - Country:US
Mailing Address - Phone:410-730-3704
Mailing Address - Fax:410-605-7852
Practice Address - Street 1:10 N GREENE ST
Practice Address - Street 2:PHARMACY 119
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1524
Practice Address - Country:US
Practice Address - Phone:410-605-7000
Practice Address - Fax:410-605-7852
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist