Provider Demographics
NPI:1447388715
Name:DICKERSON, JANE G (RPH)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:G
Last Name:DICKERSON
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 1:2451 LANCASTER CIR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4421
Mailing Address - Country:US
Mailing Address - Phone:205-991-6684
Mailing Address - Fax:
Practice Address - Street 1:2090 COLUMBIANA RD STE 1200
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-2153
Practice Address - Country:US
Practice Address - Phone:205-552-1702
Practice Address - Fax:205-521-7085
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist