Provider Demographics
NPI:1073833604
Name:DICKASON, LESLEY GAIL
Entity Type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:GAIL
Last Name:DICKASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 HELENE CT
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-1460
Mailing Address - Country:US
Mailing Address - Phone:707-584-7651
Mailing Address - Fax:707-584-7651
Practice Address - Street 1:1793 MARLOW RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4474
Practice Address - Country:US
Practice Address - Phone:707-544-8875
Practice Address - Fax:707-528-4914
Is Sole Proprietor?:No
Enumeration Date:2010-06-05
Last Update Date:2010-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist