Provider Demographics
NPI:1346523776
Name:DICKINSON, DAVID ANDREW
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:DICKINSON
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 1:3284 COLBY RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-9637
Mailing Address - Country:US
Mailing Address - Phone:231-893-1361
Mailing Address - Fax:231-894-5905
Practice Address - Street 1:3284 COLBY RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-9637
Practice Address - Country:US
Practice Address - Phone:231-893-1361
Practice Address - Fax:231-894-5905
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031304183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist