Provider Demographics
NPI:1962411124
Name:DICKERSON, ANTHONY G (RPH)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:G
Last Name:DICKERSON
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 1:2950 PLYMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1810
Mailing Address - Country:US
Mailing Address - Phone:360-734-5413
Mailing Address - Fax:360-676-4814
Practice Address - Street 1:2330 YEW ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-3942
Practice Address - Country:US
Practice Address - Phone:360-734-5413
Practice Address - Fax:360-676-4814
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA14727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist