Provider Demographics
NPI:1508567843
Name:DICK, CARRIE JOY (PHARMD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:JOY
Last Name:DICK
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 1:119 N ROLAND ST
Mailing Address - Street 2:
Mailing Address - City:MC BAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49657-9683
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:119 N ROLAND ST
Practice Address - Street 2:
Practice Address - City:MC BAIN
Practice Address - State:MI
Practice Address - Zip Code:49657-9683
Practice Address - Country:US
Practice Address - Phone:231-825-8175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist