Provider Demographics
NPI:1558585844
Name:DICKSON PHARMACY
Entity Type:Organization
Organization Name:DICKSON PHARMACY
Other - Org Name:DICKSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-221-5800
Mailing Address - Street 1:2700 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:N KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3251
Mailing Address - Country:US
Mailing Address - Phone:816-221-5800
Mailing Address - Fax:816-471-7765
Practice Address - Street 1:2700 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:N KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3251
Practice Address - Country:US
Practice Address - Phone:816-221-5800
Practice Address - Fax:816-471-7765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO20110191913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600586507Medicaid
2049304OtherPK