Provider Demographics
NPI:1073955902
Name:LICHTY, DEAN A (RPH)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:A
Last Name:LICHTY
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 1:48 OWANKA LN
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:MN
Mailing Address - Zip Code:56175-2033
Mailing Address - Country:US
Mailing Address - Phone:507-763-3941
Mailing Address - Fax:
Practice Address - Street 1:48 OWANLA LANE
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:MN
Practice Address - Zip Code:56175
Practice Address - Country:US
Practice Address - Phone:507-763-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist