Provider Demographics
NPI:1194193086
Name:DICKSON, WHITNEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:DICKSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 7TH STREET NORTHWEST
Mailing Address - Street 2:
Mailing Address - City:CASS LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56633
Mailing Address - Country:US
Mailing Address - Phone:817-702-3701
Mailing Address - Fax:817-920-6924
Practice Address - Street 1:425 7TH STREET NORTHWEST
Practice Address - Street 2:
Practice Address - City:CASS LAKE
Practice Address - State:MN
Practice Address - Zip Code:56633
Practice Address - Country:US
Practice Address - Phone:218-335-3220
Practice Address - Fax:817-920-6924
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist