Provider Demographics
NPI:1710209168
Name:DICKMAN, LAURIE A (BS PHARMACY)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:A
Last Name:DICKMAN
Suffix:
Gender:F
Credentials:BS PHARMACY
Other - Prefix:MISS
Other - First Name:LAURIE
Other - Middle Name:A
Other - Last Name:MAHODIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS PHARMACY
Mailing Address - Street 1:30 BROTHERHOOD PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10992-2272
Mailing Address - Country:US
Mailing Address - Phone:845-496-8012
Mailing Address - Fax:
Practice Address - Street 1:30 BROTHERHOOD PLAZA DR
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992-2272
Practice Address - Country:US
Practice Address - Phone:845-496-8012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043879-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist