Provider Demographics
NPI:1528570439
Name:CHEVELEVA-DICKINSON, DANA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:CHEVELEVA-DICKINSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:DICKINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:66 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2734
Mailing Address - Country:US
Mailing Address - Phone:269-352-5288
Mailing Address - Fax:
Practice Address - Street 1:1100 NEW HAVEN RD
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-5016
Practice Address - Country:US
Practice Address - Phone:203-729-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist