Provider Demographics
NPI:1164529707
Name:DICKEY, TONYA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:
Last Name:DICKEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 HIGHWAY 343
Mailing Address - Street 2:
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525-7429
Mailing Address - Country:US
Mailing Address - Phone:337-668-4297
Mailing Address - Fax:
Practice Address - Street 1:2418 S UNION ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5735
Practice Address - Country:US
Practice Address - Phone:337-942-3671
Practice Address - Fax:866-572-0137
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0556050491Medicare ID - Type Unspecified
LA0556050491Medicare PIN