Provider Demographics
NPI:1083891584
Name:DISSMORE, TRICIA LYN (RPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:LYN
Last Name:DISSMORE
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:LYN
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH, PHARMD
Mailing Address - Street 1:806 GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636-8003
Mailing Address - Country:US
Mailing Address - Phone:608-526-9772
Mailing Address - Fax:
Practice Address - Street 1:800 WEST AVE S
Practice Address - Street 2:SKEMP CLINIC PHARMACY
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601
Practice Address - Country:US
Practice Address - Phone:608-392-9855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1222161835P1200X
WI14754-001835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy