Provider Demographics
NPI:1215574231
Name:DICKMAN, ALAN JOHN
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:JOHN
Last Name:DICKMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4248 BRAXTON DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-3539
Mailing Address - Country:US
Mailing Address - Phone:608-371-4895
Mailing Address - Fax:
Practice Address - Street 1:2785 MILWAUKEE RD
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-6915
Practice Address - Country:US
Practice Address - Phone:608-362-7774
Practice Address - Fax:608-362-7503
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14836-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist